THE  UNIVERSITY 


a. 

* 


OF  ILLINOIS 
LIBRARY 


L161—  H41 


DIPTHERIA 

ITS 

NATURE,  HISTORY,  CAUSES,  PRETENTION, 

AND 

I  l 

'  ^  ,  y  ,•  i  |  |  |  SI 

treatment  on  Ifngienk  Jjriiwpte ; 

WITH  A 

RESUME  OR  THE  VARIOUS  THEORIES  AND  PRACTICES  OF 
THE  MEDICAL  PROFESSION. 


BY 

IT.  T.  TRAILL,  M.D.} 

AUTHOR  OF  THE  “HYDROPATHIC  ENCYCLOPEDIA,”  AND  OTHER  "WORKS  ;  PRINCIPAL 
OF  THE  HYGEIO-THERAPEUTIO  COLLEGE  J  PHYSICIAN-IN-CHIEF  TO  THE  NEW 
YORK  HYDROPATHIC  AND  HYGIENIC  INSTITUTE,  ETC.,  ETC.,  ETC. 


NEW  YORK : 

MILLER,  WOOD  <fc  CO.,  PUBLISHERS, 

No.  15  LAIGHT  STREET. 


Entered,  according  to  Act  of  Congress,  in  the  year  1362,  by 
E.  T.  TEALL, 

In  the  Clerk’s  Office  of  the  District  Court  of  the  United  States  for  the  Southern 

District  of  New  York. 


Davies  &  Kent, 

8TEBEOTYPERS  AND  ELECTROTYPES.*, 

113  Nassau  Street,  N.  T. 


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<^L. 


PREFACE. 

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The  increasing  prevalence  of  the  malady  known  as  diptheria,  in 
various  parts  of  the  United.  States,  the  disastrous  results  of  drug- 
medication,  and  the  superior  safety  and  efficacy  of  the  Hygienic  or 
Hygeio-Therapeutic  method  of  treatment,  supply  the  motive  for 
presenting  the  public  with  a  monograph  on  the  subject.  During 
the  last  two  years  I  have  been  written  to  for  information  by 
hundreds  of  heads  of  families,  in  neighborhoods  where  two,  three, 
four,  five,  six,  seven,  eight,  and  in  one  case  nine  members  of  the 
same  family  have  died  of  this  disease,  or  of  the  treatment,  or  of 
both  combined ;  and  everywhere  the  physicians  seem  to  be  in 
doubt  as  to  its  real  pathology  or  proper  treatment,  while  the  people 
are  in  consternation  because  of  its  direful  ravages.  It  has  been  my 
fortune  to  see  much  of  the  disease,  and  to  have  been  in  correspond¬ 
ence  with  many  of  the  graduates  of  my  school,  as  well  as  many 
other  professional  and  non-professional  persons  who  have  success¬ 
fully  applied  the  plan  of  treatment  recommended  in  this  work. 
And  these  circumstances  have  induced  me  to  collate  the  substance 
of  nearly  all  that  has  been  published  on  the  subject  in  this  country 
and  in  Europe,  and  to  note  the  facts  and  statistical  data  which  have 
been  presented  to  the  profession  and  the  public  through  the 
medium  of  the  journals  of  the  different  medical  schools.  The 
work,  therefore,  here  offered  to  the  public  is  intended  not  only  as 
an  exposition  of  the  true  pathology  and  proper  management  of  dip¬ 
theria,  but  as  a  record  of  all  that  is  important  which  has  been 
ascertained  in  relation  to  the  disease  and  its  treatment  to  this 
date. 

New  York  Hygienic  Institute,  No.  15  Laight  Street. 


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CONTENTS. 


PAGE 

Nosology  and  Technology  of  Diptheria .  7 

Description  of  Diptheria .  10 

Pathology  of  Diptheria .  38 

The  False  Membrane .  65 

History  of  Diptheria . 76 

Infectiousness . . 87 

Causes  of  Diptheria .  95 

Mortality  of  Diptheria .  103 

Complications .  116 

Sequelae  of  Diptheria . 120 

Morbid  Anatomy  of  Diptheria .  134 

Drug  Treatment  of  Diptheria .  158 

Hygienic  Treatment  of  Diptheria .  227 

Tracheotomy .  258 

Stimulation  vs.  Antiphlogistication .  261 


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“  •  -»  •*••••%*«•*#* 


DIPTHERIA. 

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NOSOLOGY  AND  TECHNOLOGY. 

The  malady  now  generally  known  as  diptheria , 
diptherite ,  or  diptheritis ,  has  been  a  perplexing  theme 
to  the  nosologists  ever  since  its  first  recognition  as  a 
distinct  disease.  Some  have  classified  it  with  croup ; 
others  have  regarded  it  as  a  modification  of  malignant 
scarlatina ,  while  others  have  considered  it  to  be  an 
affection  sui  generis .  It  certainly  presents  many  of 
the  characteristics  of  that  form  of  scarlet  fever  which 
has  prevailed  extensively  in  many  places  under  the 
name  of  putrid  sore  throaty  while  the  exndation  of  a 
fibrinous  material  on  the  mucous  surfaces  seems  to  ally 
it  closely  with  croup. 

The  term  diptheritis ,  in  its  most  literal  signification, 
implies  inflammation  of  the  skin.  By  some  authors 
it  is  employed  in  a  generic  sense,  to  include  all  affec¬ 
tions  of  the  mucous  membrane  characterized  by  the 
exudation  of  any  material  capable  of  coagulating  or 
concreting  into  a  membranous  covering  or  coating.  In 
this  sense  it  comprehends  the  true  croup ,  this  being  a 
variety  or  species  of  diptheritic  inflammation. 

Professor  George  B.  Wood,  M.D.,  of  Philadelphia 
(Wood’s  Practice  of  Medicine),  denominates  it  pseudo¬ 
membranous  inflammation  of  the  fauces.  The  term 
membranous  quinsy — angina  membranacea — has  been 
applied  to  it  by  some  authors.  Stomatitis  and( follicu¬ 
lar  inflammation  are  also  among  the  numerous  techni- 


8 


Diptheeia. 


calities  with  which  a  medical  literature,  more  wordy 
than  wise,  has  served  to  confuse  and  mystify  the  sub¬ 
ject. 

M.  Bre.tonneau,  who  first  explained  the  precise  nature 
of  the  excretion  of  the  disease,  applied  the  term  dipthe- 
ritis  to  a  group  or  class  of  diseases  which  affect  the 
dermoid  tissue — the  skin  and  mucous  membranes — and 
which  are  characterized  by  a  tendency  to  the  formation 
of  false  membranes.  In  this  sense,  the  term  would  be 
applicable  to  certain  cases  of  catarrh  in  the  bladder , 
tubular  diarrhea ,  and  dysmenorrhea ,  for,  in  all  of  these 
cases,  there  is  frequently  a  similar  exudation  of  lymph, 
and  the  formation  of  preternatural  membranous  con¬ 
cretions,  which  are  cast  off  in  fragments,  and  often 
accompanied,  especially  in  the  case  of  the  uterine 
affection,  with  excruciating  suffering.  These  morbid 
membranous  formations  have  not  unfrequently  been 
mistaken  for  a  sloughing  or  casting  off  and  discharge 
of  the  mucous  membrane  itself. 

A  malady  closely  allied,  if  not  identical  with  dip- 
theria,  or  scarlatina  maligna ,  has  prevailed  as  an 
epidemic  among  domestic  animals  as  well  as  among 
human  beings.  Thirty  or  forty  years  ago  it  prevailed 
extensively  in  western  Hew  York,  and  was  there 
termed  “  black  tongue .”  It  was  very  fatal,  as  is  the 
disease  of  human  beings  known  as  “  putrid  sore  throat.” 

“  The  medical  history  of  the  present  century,”  says 
Edward  Headlaw  Greenhow,  M.D.,  of  St.  Thomas’ 
Hospital,  London,  in  a  late  work  on  diptheria,  “  is 
remarkable  for  the  reappearance  in  this  country  of  two 
very  definite  forms  of  epidemic  disease  described  by 
the  physicians  of  former  centuries,  but  unknown  to 
our  immediate  predecessors.  I  have  elsewhere  shown 

that  the  disease  which  in  our  dav  is  called  Asiatic  or 

*/ 


Nosology  and  Technology. 


9 


epidemic  cholera,  is  identical  with  a  disease  named 
dysenteria  incruenta  by  Willis,  and  diarrhea  colliqua- 
tiva  by  Morton,  which  prevailed  during  many  years 
of  the  middle  and  latter  part  of  the  seventeenth  cen¬ 
tury.  The  kind  of  epidemic  sore  throat,  now  called 
diptheria,  which  has  prevailed  so  extensively  during 
the  last  four  years,  though  unknown  to  the  last  two  or 
three  generations  of  physicians,  was  familiar  to  the 
medical  practitioners  of  this  country  about  the  middle 
of  the  eighteenth  century,  under  the  names  of  malig¬ 
nant  sore  throat,  epidemic  croup,  and  morbus  strangu- 
latorius.  Both  cholera  and  diptheria  have,  it  is  true, 
been  observed  from  time  to  time  in  a  sporadic  form ; 
and  small  outbreaks  of  each  of  these  diseases  have 
sometimes  occurred — but  in  an  epidemic  form  they 
had  been  long  unknown,  when  they  reappeared  in  our 
own  time.” 

“The  terms  cholera  and  diptheria  are,  generally 
speaking,  and  perhaps  properly,  only  applied  to  the 
malignant  forms  of  these  epidemic  diseases,  to  the 
exclusion  of  the  milder  and  commonly  more  numerous 
cases  of  illness  induced  by  the  epidemic  influence. 
These  milder  cases,  although  characterized  by  an  affec¬ 
tion  of  the  same  mucous  surfaces,  lack  the  more  strik¬ 
ing  features  usually  understood  to  be  associated  with 
the  terms  cholera  and  diptheria.  The  mucous  surface 
of  the  alimentary  canal  is  alike  the  seat  of  the  princi¬ 
pal  phenomena,  both  in  cholera  and  the  diarrhea 
which  commonly  prevails  so  extensively  during  a 
visitation  of  cholera.  The  mucous  membrane  of  the 
throat,  especially  of  the  tonsils  and  immediately  adja¬ 
cent  parts,  is  not  only  the  seat  of  the  simpler  form  of 
sore  throat  which  has  prevailed  so  extensively  during 
the  last  three  or  four  years,  but  is  likewise,  almost 

1* 


10 


Diptheria. 


invariably,  the  situation  in  which  the  first  symptoms 
of  the  more  severe  cases,  properly  termed  diptheria, 
manifest  themselves.  The  diarrhea  of  cholera  times 
does  not  present  the  excessive  prostration,  the  blue, 
cold,  clammy  surface,  the  pulseless  extremities,  or  the 
whispering  voice  of  fully  developed  cholera  ;  the  sim¬ 
pler  sore  throats  which  have  usually  prevailed  simul¬ 
taneously  with  diptheria  have  been  often  unattended 
by  the  characteristic  exudation  of  false  membrane,  or 
by  the  prostration  of  strength,  and  have  rarely,  if 
ever,  been  followed  by  the  rancous  nasal  voice,  the 
paralysis  of  the  muscles  of  deglutition  or  of  locomo¬ 
tion,  and  the  impaired  vision  which  so  frequently  fol¬ 
low  in  the  train  of  diptheria ;  but  the  diarrhea  and 
sore  throat  are  respectively  congeners  of  cholera  and 
diptheria,  from  which  their  difference  is  less  one  of 
character  than  of  degree.” 

Dr.  Gfreenhow  limits  the  term  diptheria  to  the 
inflammation  of  mucous  surfaces  characterized  by 
membranous  exudation,  but  employs  it  generically  to 
comprehend  all  forms  of  sore-throat  affection  attended 
with  this  exudation. 

DESCRIPTION  OF  DIPTHERIA. 

The  following  description  of  the  disease,  taken  sub¬ 
stantially  from  the  late  work  of  Dr.  Greenhow,  is  the 
most  accurate  and  carefully  drawn  of  any  which  I 
have  seen,  as  applicable  to  the  great  majority  of  cases: 

“  Diptheria,  comparatively  rare  as  a  sporadic  disease, 
prevails  as  an  epidemic,  in  which  form  it  often  exists 
cotemporaneously  over  considerable  tracts  of  country, 
or  it  may  occur  in  smaller  groups,  limited  to  particular 
hamlets,  or  even  to  particular  houses.  Sometimes  it 


Description. 


11 


has  prevailed  so  extensively  that  distant  countries,  in¬ 
cluding  portions  both  of  the  Old  and  New  World, 
have  been  simultaneously  or  successively  visited  by  it. 

“Diptheria  is  sometimes  preceded,  and  usually  ac¬ 
companied,  with  fever,  which,  in  certain  epidemics  and 
in  severe  cases,  is  only  transient,  speedily  giving  place 
to  depression.  There  is  often  a  stiffness  of  the  neck  at 
the  commencement  of  an  attack,  and  usually  more  or 
less  swelling  and  tenderness  of  the  glands  at  the  angles 
of  the  lower  jaw.  The  tonsils  are  commonly  swollen, 
and,  together  with  the  immediately  contiguous  parts 
of  the  mucous  surface,  more  or  less  inflamed.  Some¬ 
times  the  swelling  and  inflammation  subside  without 
further  local  mischief ;  at  others,  the  inflamed  surface 
presents,  from  an  early  stage  of  the  disease,  whitish 
specks,  or  patches,  or  a  continuous  covering  of  a  mem- 
braniform  aspect,  which  may  appear  as  a  mere  thin, 
almost  transparent  pellicle,  but  usually  soon  becomes 
opaque,  and  in  some  cases  assumes  the  appearance  of 
wet  parchment  or  chamois  leather.  This  membranous 
concretion  varies  in  color  from  being  slightly  opaque 
to  white,  ash-color,  buff,  or  brownish,  and  in  rarer 
instances  to  a  blackish  tint. 

“  This  false  membrane  is  a  true  exudation  which  has 
coagulated  upon  the  mucous  surface,  from  which  it 
may  often  be  readily  separated,  leaving  the  subjacent 
membrane  mostly  unbroken,  or  merely  excoriated, 
usually  reddened,  vascular,  tender,  and  dotted  with 
small  bloody  specks  or  points,  but  sometimes  super¬ 
ficially  ulcerated,  and  more  rarely  in  a  sloughing  con¬ 
dition.  When  the  false  membrane  has  been  artificially 
removed,  it  is  apt  to  be  renewed  ;  and  when  not  med¬ 
dled  with,  to  become  thicker  by  continued  exudation 
from  the  mucous  surface.  The  severity  of  the  disease 


12 


Diptiieeia. 


is  commonly  in  proportion  to  the  continuity  and  dens¬ 
ity  of  the  exudation ;  hut  cases  sometimes  occur  in 
which  the  membranous  exudation  is  inconsiderable, 
and  yet  the  general  symptoms  are  of  a  very  alarming 
kind.  If  the  patches  are  small  and  remain  distinct, 
the  case  ordinarily  runs  a  favorable  course  ;  if  they 
rapidly  spread  and  coalesce,  if  the  membrane  becomes 
thick,  and  especially  if  it  assumes  a  brownish  or 
blackish  color,  danger  is  imminent.  In  proportion  as 
the  membrane  increases  in  thickness  and  density,  does 
its  attachment  to  the  subjacent  surface  generally  be¬ 
come  firmer.  The  surface  of  the  mucous  membrane 
around  the  exudation  is  red  and  vascular,  and  so  tender 
that  in  severe  cases  it  bleeds  on  the  slightest  touch. 

“  The  throat  is  in  general  the  primary  seat  of  the 
disease ;  but  the  inflammation  is  apt  to  spread  along 
continuous  mucous  surfaces,  and  thus  to  extend  up¬ 
ward  into  the  nares  and  to  the  conjunctiva ;  down  the 
pharynx  into  the  esophagus  ;  through  the  glottis  into 
the  larynx,  trachea,  and  downward  into  the  bronchial 
tubes  ;  or  forward  on  to  the  buccal  mucous  mem¬ 
brane,  the  gums,  and  lips.  Wounds  and  excoriations 
of  the  skin,  and  the  mucous  membrane  of  the  nymph se 
and  vagina  when  tender  or  irritated,  especially  in 
persons  already  suffering  of  diptheria  of  the  throat, 
are  during  an  epidemic  liable  to  undergo  the  same 
process  of  exudation,  which,  coagulating,  forms  a  false 
membrane  analogous  to  that  on  the  tonsils  and  throat. 

“  Albu  min  aria,  commencing  early  in  the  disease, 
usually  within  a  few  hours,  and  gradually  disappear¬ 
ing  with  the  local  affection,  sometimes,  but  by  no 
means  invariably,  accompanies  diptheria.  If  the  urine 
be  much  loaded  with  albumen,  the  complication  is  a 
serious  one ;  but  cases  have  done  well  in  which  a  con- 


Description-. 


13 


eiderable  cloud  of  albumen  was  deposited  from  tbe 
urine  by  tbe  proper  tests,  and  very  severe  and  fatal  cases 
of  diptheria  have  been  unattended  with  albuminaria. 

“  After  a  time  the  false  membrane  is  thrown  off, 
either  entire,  so  as  to  represent  a  mold  of  the  parts  it 
covered,  or,  which  is  more  usual,  comes  away  in  shreds 
or  flakes,  intermingled  with  mucus.  Sometimes  it 
undergoes  decomposition  prior  to  separation,  giving 
rise  to  a  very  offensive  smell.  When  the  membrani- 
form  exudation  has  come  away  spontaneously,  it  is 
sometimes  repeatedly  renewed,  each  successive  false 
membrane  becoming  less  and  less  dense,  having  less 
and  less  of  the  character  of  exudation,  and  more  and 
more  of  that  mucous  secretion,  until  at  length  the 
affected  surface  is  merely  covered  with  a  thick  mucus, 
which  gradually  disappears  as  the  mucous  membrane 
recovers  its  healthy  condition.  In  other  cases  the 
exudation  is  not  renewed  when  it  has  once  been  thrown 
off,  but  the  subjacent  membrane  is  observed  to  be 
either  redder  or  paler  than  natural,  has  a  rough,  rug¬ 
ged  appearance,  or  is  depressed  below  the  adjacent 
surface  on  the  parts  where  dense  false  membrane  has 
existed.  Occasionally  sloughing  takes  place  beneath 
the  exudation,  or  even  more  deeply,  as  in  the  center  of 
a  tonsil,  and  may  implicate  the  tonsils,  uvula,  and  soft 
palate.  More  rarely  the  tonsils  suppurate.  Hemor¬ 
rhage  from  the  nose  and  throat,  independently  of  the 
co-existence  of  purpura,  often  occurs  in  the  course  of 
diptheria,  and  is  sometimes  very  profuse.  The  local 
affection  may  pass  into  a  chronic  form,  in  which  re¬ 
lapses  or  exacerbations  are  readily  produced  by  vicissi¬ 
tudes  of  weather,  or  by  exposure  to  damp  or  cold. 
Even  perfect  recovery  from  an  attack  affords  no  im* 
munity  from  the  disease  in  future. 


14 


Diptheria. 


“  A  peculiar  character  of  the  voice,  resembling  that 
produced  by  affections  of  the  throat  in  secondary 
syphilis,  is  a  common  result  of  diptheria,  and  often 
continues  for  many  weeks  after  recovery.  The  power 
of  swallowing  is  sometimes  so  impaired  that  there  has 
been  difficulty  in  sustaining  life  during  convalescence ; 
and  the  liquids  especially  are  apt,  even  after  a  com¬ 
paratively  slight  attack  of  the  disease,  to  be  re¬ 
gurgitated  through  the  nostrils.  Extreme  anemia, 
impairment  of  vision,  a  peculiar  form  of  paraplegia, 
weakness  of  the  hands  and  arms,  numbness,  tender¬ 
ness  of  the  limbs,  tingling,  wandering  pains,  and  more 
rarely,  nervous  sequelse  of  a  hemiplegic  character,  are, 
in  the  order  here  written,  ulterior  consequences  of 
diptheria.  Gastrodynia,  and  sometimes  dysenteric 
diarrhea,  occasionally  follow  diptheria.  Pain  of  the 
ear,  deafness,  and  abscess  are  occasional  but  rare 
results  of  the  disease.” 

In  Braithwaite*  s  Retrospect  for  January,  I860,  is  a 
graphic  and  very  accurate  description  of  the  disease  in 
its  severer  form,  by  James  P.  McDonald,  Esq.,  of 
Bristol,  England,  who  has  treated  a  large  number  of 
cases : 

“  I  consider  diptheria  to  be  a  disease  produced  by  a 
specific  poison  taken  into  the  system,  acting  through 
the  blood  and  seen  at  the  throat.” 

""Bn  the  above  passage  the  author  confounds  the 
poison  itself,  or  cause  of  the  disease,  with  the  effect. 
What  is  seen  at  the  throat* is  not  the  specific  poison 
which  induces  the  disease,  but  the  excretion  by  means 
of  which  the  living  system  undertakes  to  cleanse  itself 
of  the  morbific  material,  and  the  idea  that  the  poison 
“  acts  through  the  blood”  is  a  part  of  the  false  theory 
of  disease  entertained  by  the  whole  medical  profession. 


Description. 


15 


Poisons  do  not  act  on  nor  throngli  the  blood,  nor  any 
of  the  tissues  or  organs.  They  do  not  act  at  all.  But, 
on  the  contrary,  the  living  machinery  acts  to  expel 
them,  and  this  expulsive  process  is  the  disease ,  strange 
as  this  announcement  may  sound  to  ears  unaccustomed 
to  regard  disease  as  a  process  of  purification  and  rep¬ 
aration — a  remedial  effort. 

Mr.  McDonald  continues  :  “  The  following  are  the 
usual  form  and  course  of  the  disease  in  its  severest 
type.  The  patient  is  suddenly  (and  generally  in  the 
morning)  seized  with  violent  vomiting  of  a  thin,  yel¬ 
lowish-white  matter  of  a  very  offensive  character ;  then 
purging  of  a  fluid  of  similar  appearance  and  smell. 
These  dejections  last  an  hour  or  so,  and  are  followed 
by  great  prostration  and  stupor.  The  patient  lies  for 
a  period  varying  from  six  to  sixteen  hours  in  a  heavy 
sleep,  from  which  he  is  with  difficulty  aroused,  and 
then  only  to  sleep  again.  The  skin  is  hot ;  pulse  100  ; 
the  tongue  is  of  a  bright  red ;  drink  is  taken  with 
avidity,  if  offered,  but  only  to  be  immediately  returned. 
And  now  the  important  question  is  put,  ‘  Is  the  throat 
sore  V  The  answer  is  always  the  same — c  not  in  the 
least?  The  reply,  to  the  inexperienced  in  the  horrible 
malady,  may  be  fatal  to  the  patient.  The  diagnosis  is 
that  this  is  not  a  case  of  diptheria.  On  the  other  hand, 
the  experienced  man  expects  this  reply  ;  he  forthwith 
carefully  examines  the  throat,  and  then  he  sees  the  dis¬ 
ease.  In  this  early  stage  the  tonsils,  the  soft  palate, 
and  the  back  of  the  pharynx  present  a  bright,  shining 
red  appearance.  The  small  vessels  are  not  seen  indi¬ 
vidually  injected,  as  in  many  forms  of  sore  throat,  but 
the  appearance  is  as  though  the  parts  had  been  brightly 
painted  and  then  varnished.  Hanging  from  the  velum 
to  the  tongue  is  seen,  in  this  stage,  a  transparent  film 


16 


Diptiiekia. 


of  a  tenacious  fluid,  which  is  burst  by  expiration,  send¬ 
ing  its  particles  over  the  mouth  and  the  instrument 
used  to  depress  the  tongue.  The  next  moment  a  sim¬ 
ilar  curtain  is  formed.  After  a  period  varying  from 
six  to  sixteen  hours,  the  condition  of  the  patient  mate¬ 
rially  changes.  The  stupor  has  passed  off,  and  delir¬ 
ium,  often  of  a  violent  character,  takes  its  place ;  there 
are  the  usual  symptoms  of  cerebral  excitement,  and  the 
fever  runs  high ;  breathing  is  quickened ;  the  voice  is 
changed  to  a  thick  yet  shrill  tone ;  there  is  a  short, 
dry  cough  (in  children  evidence  of  coming  croup) ;  the 
neck  is  puffy  and  blushed ;  the  tongue  is  coated  with 
a  white  fur,  and  all  those  parts  hitherto  so  brilliantly 
red,  are  thickly  spotted  with  a  whitish  substance, 
which,  in  a  wonderfully  short  period,  conglomerates 
and  forms  one  thick,  plastic  deposit,  which  in  time 
may  cover  the  whole  palate  to  the  teeth,  so  that  the 
appearance,  on  opening  the  mouth,  is  as  though  it  were 
lined  with  plaster-of-Paris.  The  violent  delirium  then 
subsides ;  the  powers  of  life  fail  rapidly ;  the  horrible 
sensations  of  choking  and  suffocation  come  on ;  the 
sufferer  tears  at  his  neck  with  his  nails,  and  tries  to 
open  his  mouth,  yet  full  power  of  swallowing  still  con¬ 
tinues,  and  he  greedily  gulps  anything  given  him  in 
the  shape  of  drink ;  large  livid  spots  form  on  the  ex¬ 
tremities,  amounting  sometimes  to  purpura ;  the  diar¬ 
rhea,  of  a  white  and  offensive  matter,  is  increased; 
muttering  delirium  comes  on,  and  in  a  long  tetanic 
convulsion,  death  closes  the  scene. 

“This  is  a  truthful  picture,  drawn  from  realities,  of 
how  a  previously  strong  and  healthy  man  may,  in  six' 
days  or  less,  cease  to  be. 

“  Taking  the  above  as  a  fair  example  of  diptheria  in 
its  most  marked  and  deadly  aspect,  as  I  have  seen  it, 


Desceiptiox. 


17 


we  get  the  resemblance  to  it,  more  or  less,  in  all  minor 
cases.  "We  must  not  expect  to  meet  with  all  the  symp¬ 
toms  in  every  case,  but  the  condition  of  the  throat  is 
invariable.  Whether  that  condition  goes  on  to  the 
second  stage,  depends  on  the  severity  [quantity  ?]  of  the 
poison  or  the  success  of  the  treatment  adopted.  In  all 
cases  where  there  is  either  nausea  or  vomiting,  followed 
by  drowsiness,  the  throat  ought  to  be  examined,  and 
if  the  redness  and  the  ‘  glassy  curtain’  appear,  the  im¬ 
mediate  use  of  the  proper  appliances  may,  I  am  quite 
certain,  save  many  valuable  lives.” 

'In  the  same  journal  is  an  article  from  the  pen  of 
Thomas  ITeckstall  Smith,  Esq.,  surgeon  to  St.  Mary 
Cray,  Kent,  who  distinguishes  three  forms  of  dipthe- 
ria :  “  There  are  three  forms  in  which  the  disease  pre¬ 
sents  itself,  viz.,  simple  ash-colored  diptheria  membrane 
in  patches,  with  very  slight  congestion  of  the  surround¬ 
ing  parts,  and  without  fetor.  Secondly,  a  deeper  color, 
and  more  widely-spread  membranous  exudation,  with 
fetid  breath  and  intense  engorgement  of  dark  hue. 
Thirdly,  the  membrane  with  much  tonsillitis,  in  a  few 
cases  resulting  in  quinsy.  But  there  has  been  a  fourth 
and  more  formidable  state  of  things  to  contend  with, 
namely,  an  extension  of  the  membrane  in  either  of  the 
above  forms,  to  the  larynx  and  trachea,  the  symptoms 
of  which  I  need  not  describe.” 

In  a  paper  read  before  the  Kew  York  Academy  of 
Medicine,  January,  1861,  by  David  Winne,  M.D.,  of 
the  University  Medical  School,  the  symptoms  are  thus 
described  :  u  Diptheria  is  frequently  attended  with  very 
slight  constitutional  disturbance  at  the  commencement 
of  the  attack,  even  where  the  disease  is  destined  to  a 
fatal  termination.  The  patient  is  often  so  little  af¬ 
fected,  that,  with  the  exception  of  some  slight  difficulty 


18 


Diptpieria. 


iii  tlie  act  of  deglutition,  he  exhibits  no  evidences  of  dis¬ 
ease,  and  it  is  with  difficulty  that  the  parents  can  be 
brought  to  consider  this  symptom  as  one  of  much  im¬ 
portance,  or  the  child  in  very  serious  danger. 

“  After  a  short  interval,  however,  one  of  the  tonsils 
— seldom  both — becomes  specked  with  a  yellowisli- 
white  deposit,  which,  when  seen  at  this  early  stage, 
presents  the  appearance  of  small  whitish  stars  in  the 
midst  of  a  ground  of  what  appears  to  be  a  transparent 
layer  of  mucus,  but  which  really  is  the  true  diptherial 
membrane  through  which  the  body  of  the  tonsil,  often 
of  an  increased  redness,  is  distinctly  seen.  These  spots, 
small  at  first,  rapidly  enlarge,  the  membrane  loses  its 
transparency,  and  if  not  speedily  arrested,  spreads  over 
the  soft  parts  of  the  palate,  both  tonsils,  the  uvula,  and 
involves  the  larynx,  and  sometimes  the  trachea  and 
bronchial  tubes. 

“  Usually,  even  in  slight  cases,  the  local  symptoms 
are  preceded  by  some  constitutional  disturbance.  There 
is  a  feeling  of  malaise,  pain  in  the  head,  often  extend¬ 
ing  to  the  neck  ;  lassitude,  and  more  or  less  fever.  In 
the  mild  form  the  tongue  presents  a  thick  creamy  coat, 
through  which  a  few  papillae  are  visible ;  the  uvula, 
the  velum  palati,  and  pharynx  are  of  a  bright  red  color, 
and  the  tonsils  swollen  and  specked  with  a  filmy  de¬ 
posit,  already  described,  which  is  generally  closely  ad¬ 
herent  to  the  mucous  membrane,  although  in  some 
cases  it  is  easily  removed  in  its  earlier  stages  by  the 
application  of  the  sponge  probang,  which  is  often 
coated  with  the  new-formed  deposits. 

“  This  membranous  exudation  may  extend  over  the 
whole  palate,  but  in  mild  cases  rarely  does  ;  nor  is  its 
color  much  deepened,  or  the  odor  emitted  offensive  or 
fetid.  The  submaxillary  glands  are  slightly  swollen, 


Description. 


19 


but  do  not  attain  the  size  which  they  acquire  in  the 
severer  forms  of  the  disease.  Under  favorable  cir¬ 
cumstances,  or  the  application  of  judicious  treatment, 
its  progress  is  here  arrested.  The  membrane  ceases  to 
spread,  and  slowly  becomes  detached  from  its  connec¬ 
tions  ;  the  mucous  membrane  loses  its  red  color ;  the 
glandular  swellings  subside  ;  the  pulse  diminishes  in  fre¬ 
quency,  and  the  patient  becomes  decidedly  convalescent. 

“  The  disease,  however,  does  not  always  present 
itself  in  this  form,  but  is  ushered  in  by  rigors  and 
often  vomiting,  under  whose  influence  the  patient  be¬ 
comes  so  prostrated,  that  it  soon  becomes  obvious  that 
th6  system  is  oppressed  by  a  powerful  poison.  This 
condition  is  characterized  by  a  high  [violent?]  fever, 
a  pungent  skin,  a  rapid  and  feeble  pulse,  great  diffi¬ 
culty  in  deglutition,  hurried  respiration,  flushed  coun¬ 
tenance,  and  congested  lips  ;  the  tongue  becomes  loaded 
with  a  yellow  or  dirty  brown  coat ;  the  soft  palate  and 
pharynx  assume  a  deep  erysipelatous  redness ;  the 
tonsils  become  greatly  swollen,  and  the  ash-colored 
membrane,  nearly  continuous  and  spread  over  one  or 
both  tonsils,  extends  to  the  uvula  and  the  posterior 
walls  of  the  pharynx.  As  the  disease  advances,  these 
symptoms  increase  in  severity  ;  the  breathing  becomes 
more  hurried  and  stertorous  ;  the  swallowing,  which  at 
first  was  but  moderately  impeded,  becomes  so  trouble¬ 
some  and  painful,  that  the  child  is  with  great  difficulty 
induced  to  take  either  food  or  medicine  ;  the  saliva 
flows  from  the  mouth,  and  often  a  foul  and  acrid  dis¬ 
charge  from  the  nostrils.  Should  the  little  patient  be 
induced  to  swallow,  food  or  drink  will  be  violently 
ejected,  and  a  paroxysm  of  great  intensity,  in  which 
the  child  will  gasp  for  breath,  and  with  great  difficulty 
recover  itself,  will  ensue. 


20 


Diptheria. 


“The  case  lias  now  reached  a  point  which  portends 
the  most  unfavorable  results.  The  false  membrane  has 
seized  upon  every  visible  part  of  palate  and  pharynx ; 
the  discharge  of  sanies  mixed  with  blood,  which  issues 
from  the  mouth  and  nose,  has  become  exceedingly 
offensive  ;  the  glands  of  the  neck  become  enlarged  and 
tender,  the  voice  hoarse  and  indistinct,  the  pulse  more 
rapid  and  feeble,  and  the  poor  patient,  restless  and 
embarrassed  for  want  of  breath,  tosses  about  or  lies  on 
his  back  in  a  semi-comatose  state  ;  in  most  cases  the 
medical  attendant  is  apprised  by  a  croupy  respiration 
when  the  membrane  has  invaded  the  larynx  and 
trachea,  at  wdiich  time  symptoms  of  asphyxia  present 
themselves ;  the  countenance  becomes  livid,  the  skin 
cold,  the  pulse  feeble  or  gone,  and  the  patient,  either 
distressed  for  want  of  breath,  anxiously  awaits  the 
moment  when  death  shall  relieve  him  of  his  sufferings, 
or  rapidly  sinks  into  an  asthenic  or  comatose  condi¬ 
tion.” 

The  careful  reader  will  not  fail  to  notice  some  dis¬ 
crepancies  in  the  symptoms,  as  described  by  the  various 
authors  thus  far  and  hereafter  to  be  quoted,  a  fact 
which  shows  the  great  diversity  of  forms  and  the 
various  degrees  of  malignancy  under  which  the  dis¬ 
ease  appears  in  different  persons. 

A.  C.  Hamlin,  M.D.,  Surgeon  2d  Regiment  Maine 
Volunteers,  in  an  article  published  in  the  Hew  York 
Medical  Times  of  Feb.  22, 1862,  makes  the  following 
remarks  in  relation  to  diptheria  as  it  prevailed  in  his 
department  of  the  army:  “  Since  the  commencement 
of  the  campaign,  some  thirty  cases  of* diptheria  have 
been  observed  by  us,  most  of  which  have  been  so  ob¬ 
scure  and  complicated  as  to  render  diagnosis  perplex¬ 
ing,  and  often  inclining  us  to  doubt  whether  the  malady 


Description. 


21 


merited  a  distinction  from  some  other  phlegmasias  of 
the  throat  by  reason  of  functional  symptoms  and 
physical  signs.  Rarely  did  it  commence  with  the 
pellicle  of  Bretonneau,  though  it  afterward  assumed 
many  of  the  peculiarities  of  the  disease  in  an  ad¬ 
vanced  stage.  Sometimes  the  exudation  appeared  like 
cryptogamous  vegetation ;  then,  again,  there  were 
ulcerated  fissures  or  irregular  patches  with  flake-like 
lymph.  All  the  cases  appeared  during  or  after  wet 
and  stormy  periods,  when  the  atmospheric  variations 
were  sudden  and  the  electric  oscillations  considerable. 
All  ended  in  resolution,  without  serious  injury  to  the 
system  except  one,  in  which  instance  death  ensued  from 
hemorrhage  of  the  palatine  or  pharyngeal  arteries. 
The  enlargement  of  the  cervical  glands  was  often  very 
great,  with  occasional  abscess.  The  attending  pyrexia 
[fever]  and  constitutional  disturbance  were  in  most 
cases  slight.” 

Dr.  Fouregaspd,  of  Sacramento,  California,  thus  de¬ 
scribes  diptheria  as  it  appeared  in  that  place : 

“  The  disease  begins  in  a  very  insidious  manner,  by 
a  little  engorgement  or  inflammation  of  the  soft  palate, 
pharynx,  and  one  of  the  tonsils.  At  this  period  the 
patient  complains  but  little — there  is  no  fever,  or  it 
is  very  moderate.  The  pain  in  the  throat  is  much 
slighter  than  in  the  usual  forms  of  sore  throat — so 
slight,  that  the  little  patients  go  about  playing  as  if 
nothing  was  the  matter.  In  some  exceptional  cases, 
the  fever  and  inflammation  about  the  pharynx  are  con¬ 
siderable  from  the  beginning.  The  characteristic  signs 
of  the  invasion  soon  follow.  They  consist  in  small 
portions  of  white  or  yellowish  lymph  deposited  on  the 
palate,  the  tonsils,  and  the  posterior  part  of  the  pharynx. 
The  cervical  and  submaxillary  glands  become  swollen, 


22 


Diptiieeia. 


and  the  pain  in  swallowing  and  opening  the  mouth  is 
occasioned  more  by  the  engorged  state  of  the  glands 
than  by  the  internal  secretion  of  lymph.  These  de¬ 
posits  go  on  increasing  in  size  more  or  less  rapidly, 
and  in  violent  cases  in  a  few  hours  the  whole  cavity 
of  the  throat  is  covered  by  them.  Generally  one  side 
is  more  affected  than  the  other,  and  the  glands  corre¬ 
sponding  with  the  parts  affected  are  more  swollen  than 
those  of  the  opposite  side.” 

Dr.  Blake,  of  California,  in  the  Pacific  Medical  and 
Surgical  Journal ,  August,  1858,  describes  the  access 
and  progress  of  the  disease  :  “  Drowsiness,  prostration, 
or  oppression  is  manifested  by  infants,  or  complained 
of  by  adults ;  and  when  the  disease  is  prevailing,  this 
desire  of  children  to  sleep  at  other  than  usual  hours 
should  awaken  our  suspicion.  The  pulse  is  accel¬ 
erated  from  the  first,  but  generally  soft  and  typhoid ; 
although  in  some  cases  it  is  for  a  few  hours  rather  hard. 
The  temperature  of  the  skin  is  raised,  although  seldom 
harsh  or  dry ;  and  frequently  moist,  or  even  covered 
with  profuse  perspiration.  There  is  seldom  any  pain  ; 
rarely  headache  or  backache.  The  tongue  is  usually 
coated,  edges  red,  papillse  prominent.  The  appetite 
may-  remain  good,  and  the  digestion  unimpaired.  If 
we  examine  the  throat  we  may  find,  even  within 
twelve  hours  after  the  occurrence  of  the  first  slight 
symptom,  the  tonsils  covered  with  a  gray,  pultaceous 
exudation,  which  rapidly  extends  upward  into  the  nos¬ 
trils,  and  downward  toward  the  larynx  ;  and  again, 
we  may  detect  only  a  redness  of  the  tonsils  and  a  small 
point  of  exudation,  two  or  three  days  after  the  com¬ 
mencement  of  the  disease,  and  at  a  time  when  the 
symptoms  of  general  prostration  had  become  alarming. 
Again,  cases  may  present  themselves  in  which  the 


Description. 


23 


general  symptoms  and  the  anatomical  lesions  proceed 
pari  passu  •  but  in  almost  every  case  that  I  have  seen 
I  have  considered  that  death  was  the  result  rather  of  the 
action  of  the  poison  on  the  system  than  from  obstruction 
of  the  larynx.  In  from  twelve  to  twenty-four  hours  after 
the  formation  of  the  false  membrane,  we  generally  find 
the  cervical  glands  enlarged,  and  in  severe  cases  this 
enlargement  may  afford  a  serious  obstacle  to  respira¬ 
tion  and  deglutition.” 

Professor  Alonzo  Clark,  M.D.,  of  the  Hew  York 
College  of  Physicians  and  Surgeons,  in  his  lectures 
on  diptheria,  as  published  in  the  Hew  York  Medieal 
Times ,  distinguishes  between  epidemic  sore  throat, 
which  has  little  tendency  to  the  production  of  mem¬ 
brane,  and  true  diptheria — the  former  being  com¬ 
paratively  a  mild  disease.  The  difference,  however, 
may  be  more  in  degree  than  in  kind. 

Dr.  Clark,  limiting  the  term,  diptheria,  to  such  forms 
of  inflammation  as  terminate,  or  have  in  their  course 
this  membrane  as  a  sign,  thus  describes  the  order  of 
symptoms : 

“  As  to  its  initiatory  symptoms,  they  have  no  definite 
relation  to  the  future  severity  of  the  disease  or  to  the 
parts  that  are  to  be  the  seat  of  the  inflammatory  exu¬ 
dation.  When  diptheria  appeared  among  us  for  the 
first  time  as  a  prevailing  disease,  the  cases  that  I  saw 
wTere  almost  all  of  them  ushered  in  by  pretty  acute 
symptoms  ;  a  chill,  followed  by  a  fever  ;  and  then,  in 
a  small  proportion  of  cases,  a  chill  and  fever  alter¬ 
nating  two  or  three  times  in  the  course  of  a  single  day. 
Those  instances  in  which  the  chill  was  repeated  were 
rare ;  but  a  very  decided  invasion  was,  in  the  cases 
that  I  saw,  the  rule  in  the  beginning  of  the  disease. 
As  it  went  on,  the  symptoms  of  invasion  were  less  and 


24: 


Dipthebia. 


less  marked,  and  not  unfrequently,  as  is  now  noticed, 
it  occurs  without  any  that  attracted  attention.  Several 
instances  of  this  kind  now  occur  to  my  mind  ;  hut  two 
of  these  will  serve  for  illustration : 

“  Two  children,  two  and  a  half  and  four  years  of 
age,  were  observed  to  have  the  symptoms  of  slight  ca¬ 
tarrh  for  two  or  three  days,  but  there  was  nothing  to 
awaken  anxiety.  They  followed  their  amusements  in 
the  nursery  as  usual,  when  at  length  the  mother  no¬ 
ticed  a  croupy  cough  in  the  youngest,  and  sent  for  the 
family  physician.  He  found  the  usual  early  symptoms 
of  croup,  and  a  diptheritic  membrane  on  the  tonsils, 
extending  downward  beyond  the  reach  of  sight.  He 
examined  the  other  child’s  throat,  not  because  he  ex¬ 
pected  to  find  any  evidence  of  grave  disease,  but  from 
motives  of  prudence,  and  was  surprised  to  find  the  ton¬ 
sils  almost  completely  covered  with  false  membrane. 
The  youngest  grew  rapidly  worse,  and  in  four  days 
died  of  diptheritic  croup.  The  eldest  was  at  no  time 
dangerously  sick,  and  did  not  keep  her  bed  a  single 
day.  The  membrane  was  detached  in  two  days,  and 
did  not  reappear.  The  only  medicines  were  tonics  and 
chlorate  of  potassa,  with  full  nutrition.  Bretonneau, 
in  examining  the  throats  of  young  persons  in  a  school 
where  diptheria  was  prevailing,  found  the  membrane 
in  many  instances  where  there  was  no  complaint  of  ill 
health,  and  where  it  was  not  suspected  till  it  was  ac¬ 
tually  found.  Such  cases  will  teach  you  two  import¬ 
ant  lessons first,  that  the  disease  does  not  always 
make  its  invasion  by  any  symptoms  calculated  to  ex¬ 
cite  alarm ;  and  secondly,  that  those  symptoms,  when 
once  declared,  are  to  be  considered  by  no  means  as  a 
measure  of  its  severity.  It  is  not  easy,  then,  to  fix  in 
very  definite  terms  the  character  of  the  invasion,  the 


Description. 


25 


symptoms  being  sometimes  very  decided,  at  other 
times  very  insidious.  But  where  the  disease  is  once 
formed,  you  look  for  symptoms  relating  to  the  fauces, 
trachea,  nasal  passages,  mouth,  or  esophagus,  for  it  is 
in  these  that  the  membrane  is  most  frequently  formed. 

“  When  it  is  confined  to  the  fauces ,  there  is  often 
but  little  occasion  for  alarm.  These  are  the  cases  from 
which  most  of  the  recoveries  come.  The  breathing  is 
not  interfered  with ;  there  is  not  necessarily  much 
cough ;  the  general  health  may  not  suffer  materially. 
And  yet,  let  me  say  to  you,  that  when  it  forms  in  the 
fauces  only,  and  does  not  extend  beyond,  you  will  not 
unfrequently  find,  as  the  disease  advances,  the  most 
formidable  symptoms ;  and  as  we  shall  see,  by-and-by, 
too  often  a  fatal  result. 

“  When  it  advances  into  the  nasal  passages,  you  will 
have  indications  somewhat  before  the  formation  of  the 
membrane.  You  will  usually  see  it  in  the  fauces, 
perhaps  folding  back  beyond  your  view  upon  the  pal¬ 
ate  ;  the  nose  will  become  a  little  red,  and  there  will 
be  a  little  snuffling  upon  one  or  both  sides ;  directly 
there  is  a  discharge  of  a  yellowish  watery  or  ichorous 
matter,  nearly  transparent.  This  may  irritate  the  skin 
of  the  lip  a  little,  and  may,  in  the  end,  cause  swelling 
of  the  upper  lip  itself.  Soon  after  this  discharge 
makes  its  appearance,  there  may  be  seen  forming  upon 
the  swollen  mucous  surfaces  a  delicate  membrane,  and 
this,  growing  thicker  and  more  abundant,  will  not  un¬ 
frequently  stand  out  upon  the  white  tissues  joining  the 
red  of  the  nose.  And  then  still  the  ichorous  matter 
will  continue  to  be  discharged;  it  will  sometimes  dry 
up  on  the  false  membrane,  and  finally  plug  up  the  nos¬ 
trils  altogether,  so  that  respiration  can  be  performed 
only  through  the  mouth.  At  other  times  the  nostrils 

2 


26 


Diptheria. 


are  not  plugged  up,  and  breathing  through  them  is 
only  difficult. 

“  When  the  membrane  forms  in  the  esophagus ,  you 
have  no  very  decided  indications  of  its  presence  there. 
There  is  no  great  difficulty  of  swallowing  ;  there  is  no 
particular  pain  that  will  lead  you  to  the  suspicion  of  its 
formation  in  that  tube.  You  learn  it  mainly  from  the 
fact  that  ribbons,  or  a  large  membrane,  are  vomited  up, 
or  perhaps  the  same  things  may  be  found  in  the  stools, 

“But  when  the  larynx  and  trachea  are  invaded,  you 
have  the  most  formidable  variety  of  this  disease.  Then 
it  is  that  you  have  everything  to  fear.  Then  the  chances 
for  recovery  are  scarcely  so  good  as  one  in  eight  or  ten 
of  all  who  are  attached.  The  symptoms  of  this  inva¬ 
sion  of  the  trachea  and  larynx  are  precisely  or  almost 
precisely  those  of  croup.  The  voice  is  changed  ;  it 
loses  its  compass  and  strength,  and  frequently  is  re¬ 
duced  to  a  whisper.  The  breathing  becomes  noisy ;  we 
call  it  stridulous ;  the  cough,  for  the  most  part,  be¬ 
comes  hoarse  and  croupy — occasionally  shrill  and 
brassy ;  there  is  difficulty  of  breathing ;  the  child’s 
head  is  thrown  back  to  open  the  larynx  fully  and  give 
force  to  some  of  the  respiratory  muscles.  He  not  un- 
frequently  vomits,  but  this  affords  him  very  little  re¬ 
lief.  The  difficulty  of  breathing  becomes  more  and 
more  considerable  as  the  disease  increases,  and  in  some 
instances  there  is  very  marked  restlessness.  In  other 
instances  there  is  much  drowsiness.  The  surface  of  the 
body  often  shows  the  marks  of  incomplete  aeration  of 
the  blood.  The  nails  and  lips  become  blue,  or  there 
may  be  a  general  cyanotic  condition.  The  wings  of 
the  nose  are  expanded  in  inspiration.  Everything 
shows  that  the  child  is  about  to  die  from  asphyxia 
or  apnoea.  While  in  the  other  forms  of  the  disease 


Description. 


27 


children  die  from  tlie  general  influences  of  the  dip- 
theritic  poison,  these  scarcely  live  long  enough  to  ex¬ 
perience  them. 

“This  membrane  may  be  found  lining  the  whole 
mouth.  Then  it  usually  is  produced  first  in  the  fauces, 
and  extends  forward.  In  my  observation,  the  mouth 
does  not  take  on  this  diseased  action  in  the  mild  cases, 
but  rather  in  those  in  which  the  disease  is  invading 
the  nasal  and  respiratory  passages.  It  has  been  known 
to  begin  on  the  gums  (gingival  diptheria),  and  extend 
backward  into  the  fauces,  so  covering  the  mucous 
surfaces  of  the  mouth.  When  the  mouth  is  so  cov¬ 
ered,  the  red  tissues  are  everywhere — on  the  roof,  the 
inner  surface  of  the  cheeks,  the  tongue,  the  gums — 
hidden  by  a  layer  of  exudation  that  looks  like  a  half- 
dried  coating  of  plaster-of-Paris.  As  this  peels  off  por¬ 
tion  by  portion,  the  natural  structures  are  left  red  and 
shining.  This  stomatic  diptheria  alone  is  no  more 
grave  than  other  forms  of  the  same  disease,  and  much 
less  so  than  the  tracheal  variety.  It  produces  but  little 
of  actual  pain,  but  it  makes  the  mouth  stiff  and  embar¬ 
rasses  its  motions ;  destroys  the  taste  for  the  time ; 
makes  it  painful  to  talk  and  swallown  Hot  and  stimu¬ 
lating  drinks  appear  to  be  in  the  highest  degree  un¬ 
pleasant.  Indeed,  the  little  sufferers  affected  in  this 
way  sometimes  resist  every  administration  by  the 
mouth  with  a  perseverance— I  may  even  say  a  frenzy 
— which  only  an  absolute  and  apparently  cruel  firm¬ 
ness  on  the  part  of  attendants  can  overcome. 

“  In  all  these  forms  of  disease  one  feature  is  almost 
uniformly  noticeable,  and  that  is  a  swelling  of  the  glands 
at  the  angle  of  the  jaw,  and  of  those  extending  down¬ 
ward  from  this  point.  Indeed,  it  is  regarded  as  one  of 
the  diagnostic  marks  in  the  early  stage  that  these 


28 


Djpthekia. 


glands,  though  ever  so  little,  are  swollen.  They  are 
usually  swollen  unequally.  When  the  disease  is  pre¬ 
vailing,  Bretonneau  warns  us,  at  the  least  snuffling,  on 
the  slightest  indication  of  coryza,  to  feel  behind  the 
angle  of  the  jaw,  and  below  the  lobe  of  the  ear,  and  so 
down  the  side  of  the  neck  for  swollen  lymphatic 
glands.  We  are  then  to  examine  the  upper  lip.  4  In 
simple  coryza  the  skin  is  reddened  equally  under  each 
nostril,  while  in  the  Egyptian  disease  it  is  only  on  the 
side  of  the  glandular  swelling.  If  the  swelling  exists 
on  both  sides,  it  is  unequal.  On  the  side  where  the 
swelling  is  least,  the  redness  of  the  lip  will  he  least. 
From  the  period  of  this  discovery  we  are  certain  there 
is  a  special  affection — in  fact,  the  Egyptian  disease.’ 
By  ‘  Egyptian  disease,’  M.  Bretonneau  means  dip- 
theria. 

“In  this  connection,  I  may  better  say  that  this  dis¬ 
ease  may  appear  on  the  gums ,  as  it  often  appears  on 
the  tonsils,  without  extending  beyond  the  parts  it  first 
attacks.  Such  cases  belong,  in  general,  to  the  milder 
forms  of  diptheria. 

“  Among  the  rarer  seats  of  diptheritic  exudation,  I 
may  mention  the  external  ear.  This  tube  has  been 
seen  lined  by  it.  M.  Bretonneau  reports  an  instance  in 
which  the  lining  membrane  of  the  antrum  highmoria- 
num  was  fully  involved.  A  poor  Jew  had  died  while 
the  physician  was  making  preparations  for  tracheot¬ 
omy.  The  false  membrane  was  found  in  all  the  air 
passages  as  far  as  they  could  be  followed,  and  also 
making  an  adventitious  lining  of  both  maxillary  si¬ 
nuses ,  filling  both  with  a  turbid  serous  fluid,  in  which 
were  floating  bands  of  false  membrane,  as  in  a  pleu¬ 
ritic  effusion. 

“  I  have  here  a  letter  from  Dr.  Whittlesey,  physician 


Description. 


29 


to  the  Children’s  Hospital  oil  Handall’s  Island,  relating 
to  some  cases  of  dijjlhe/iiio  ophthalmia  that  occurred 
there  some  time  ago.  Dr.  Hives,  assistant  physician  in 
that  institution,  two  or  three  years  ago,  exhibited  to  me 
some  specimens  of  this  disease,  and  they  were  shown  to 
the  class  then  attending  lectures  here.  The  eyelids  were 
both  covered  by  a  firm,  elastic  exudation,  and  the  same 
membrane  covered  the  conjunctiva  of  the  eye  as  far  as 
the  cornea.  Dr.  Hives  informed  me  that  in  his  depart¬ 
ment  of  the  hospital  there  had  been  at  that  time  five 
cases  of  this  affection,  more  or  less  extensive,  and  that 
in  his  cases,  if  the  patient  survived,  the  inflammation 
was  destructive  to  the  eye,  and  blindness  followed. 
Dr.  Whittlesey’s  letter  informs  me  that  these  cases  oc¬ 
curred  in  the  winter  of  1851  and  ’8,  before  diptheria 
became  epidemic  in  this  city,  and  while  it  was  pre¬ 
vailing  in  Albany.  But  a  similar  disease  showed 
itself  in  that  institution  four  years  earlier.  Dr.  Whit¬ 
tlesey  states  that,  ‘  In  the  winter  of  1853-1  measles  and 
scarlet  fever  prevailed  in  this  institution,  and  there 
were  three  cases  of  diptheria.  The  patients  were  chil¬ 
dren  that  had  suffered  from  measles,  and  were  in  a 
feeble,  emaciated  condition.  They  all  died  in  a  few 
days  after  the  membranous  disease  appeared.  The 
deposit  or  exudation  was  upon  the  inside  of  both  eye¬ 
lids,  nearly  a  line  in  thickness  on  the  upper,  and  of 
such  consistence  that  it  could  be  removed  with  forceps, 
retaining  the  form  of  the  lid  as  a  cast,  presenting  an 
appearance  similar  to  that  of  the  specimen  presented 
to  you  by  Dr.  Hives.’  This  form  of  diptheria  has  been 
repeatedly  noticed  in  Europe. 

“  These  are,  liowever,  only  the  local  manifestations. 
Those  of  a  more  general  character  are  still  to  be  con¬ 
sidered.  It  not  unfrequently  happens  that  persons  who 


30 


Dxpthekia. 


have  gone  through  with  all  that  I  have  now  described 
to  you,  and  appear  to  he  recovering,  suffer  still  from  a 
prostration  that  seems  almost  unaccountable.  Take 
one  or  two  fatal  examples.  Early  in  the  occurrence  of 
the  epidemic,  in  a  patient  of  Dr.  Crane’s,  the  membrane, 
if  I  remember  rightly,  was  found,  as  it  is  commonly, 
in  the  fauces,  but  not  beyond.  The  patient  went 
through  with  the  earlier  stages  of  the  disease,  the 
membrane  exfoliated,  and  everything  seemed  to  be 
doing  well.  His  convalescence  was  announced  to  the 
friends  of  the  family.  About  ten  days  after  the  mem¬ 
brane  disappeared,  Dr.  Crane  was  called  in  haste  to 
see  the  child,  as  it  was  very  much  worse.  When  he 
reached  the  house,  he  found  that  he  was  so  much 
prostrated  that  there  was  scarcely  any  pulse.  The 
patient  had  been  sitting  up  the  earlier  part  of  the  day, 
but  now  he  could  not  raise  his  head  from  the  pillow 
without  fainting.  It  seemed  to  the  Doctor  that  there 
was  internal  hemorrhage,  yet  there  was  no  other  mani¬ 
festation  of  it.  In  this  sinking  condition  the  little  one 
remained  from  two  in  the  afternoon  until  seven  in  the 
evening,  when  he  died,  precisely,  if  I  can  judge,  as 
persons  usually  die  from  the  rupture  of  some  vessel 
that  allows  fatal  hemorrhage  into  the  intestines  or 
uterus.  On  the  morning  of  the  day  on  which  he  died, 
there  was  nothing  to  lead  to  the  suspicion  that  he 
would  not  get  well,  except  the  treacherous  nature  of 
the  disease.  In  Dr.  McCready’s  case,  already  referred 
to,  a  similar  history  is  to  be  given.  This  child  had  an 
extraordinarily  thick  membrane  formed  upon  the  tonsils 
and  uvula ;  you  see  a  portion  of  it  in  that  vial.  The 
symptoms  w^ere  those  of  ordinary  sore  throat  at  first. 
In  a  day  or  two  the  tonsils  became  covered  with  the 
membrane.  There  was  not  much  disturbance  of  the 


Description. 


SI 


general  health.  In  a  few  days  exfoliation  took  place, 
and  there  was  promise  of  speedy  recovery.  A  week 
later,  however,  membrane  appeared  in  nostrils ;  rapid 
collapse  followed,  and  the  child  died  in  twenty-four 
hours. 

u  A  son  of  Mr.  D.,  two  years  old,  had  the  diptheritic 
membrane  first  in  the  fauces,  afterward  in  the  larynx, 
and  probably  in  the  trachea.  Little  hope  was  enter¬ 
tained  of  his  recovery  for  many  days.  At  length  the 
croupous  cough,  the  rapid  and  stridulous  breathing 
slowly  subsided,  with  the.  expectoration  of  fragments 
of  membranous  matter,  and  the  child  appeared  to  be 
convalescent.  The  danger  seemed  to  have  passed,  and 
he  was  taken  into  the  countrv.  But  there  he  lost 
strength  and  flesh,  sank  into  deep  prostration,  and  died 
in  three  weeks  without  renewal  of  the  dyspnoea,  or  any 
other  symptom  of  throat  disease. 

“  Well,  now,  what  is  it  that  produced  death  under 
these  circumstances  ?  The  obvious  answer  is — a  certain 
poison,  the  nature  of  which  we  do  not  understand, 
which,  though  it  has  spent  its  force  to  produce  local 
manifestations,  has  not  yet  exhausted  its  fatal  control 
over  the  nervous  system.  It  seems  to  destroy,  making 
allowance  for  the  difference  in  time,  as  prussic  acid 
does,  by  overwhelming  the  nervous  forces.  I  know 
nothing  else  to  say  about  it.  A  case  or  two  more  to 
illustrate  this  point.  In  a  patient  on  Staten  Island, 
whom  I  saw  with  Dr.  Gunn,  the  history  is  a  little 
different,  and  yet  no  more  favorable.  A  young  lady, 
fourteen  years  of  age,  had  the  membranous  disease  of 
the  fauces ;  it  was  of  the  variety  once  called  the 
sloughing  sore  throat.  A  membrane  had  formed  of 
considerable  firmness  and  thickness,  and  apparently  in 
successive  layers;  the  older  parts  were  sloughing  off 


32 


Dipthekia. 


from  the  newer.  Her  throat  looked  as  if  there  was 
an  abundant  dirty  purulent  slough  covering  it.  This 
is  no  uncommon  appearance  ;  and  these  very  appear¬ 
ances  have  led  to  some  of  the  names  which  have  been 
given  to  this  membrane  in  the  older  time.  You  can 
hardly  believe  when  you  see  such  an  appearance  that 
it  is  not  really  a  gangrenous  condition  of  the  natural 
tissues  of  the  parts  ;  but  if  you  watch  such  a  case,  and 
it  has  a  favorable  termination,  you  will  see  that  the 
whole  of  this  material  will  clear  off  without  even  so 
much  as  a  depression  being  left.  This  was  the  condi¬ 
tion  of  the  young  lady’s  throat.  Her  breath  was 
somewhat,  but  not  markedly  fetid.  She  had  been 
sick  just  six  days,  wdien  I  saw  her.  She  had  been 
attacked  with  sore  throat  pretty  suddenly  in  church. 
Hot  having  a  chilly  feeling,  but  still  experieucing  gen¬ 
eral  discomfort,  she  left  the  church  for  her  father’s 

/ 

house.  The  physician  was  called  the  next  day,  and 
found  the  membrane.  It  continued  then,  from  Monday 
until  Saturday ;  and  now,  without  any  great  loss  of 
strength,  without  any  difficulty  in  breathing,  without 
any  membranous  formation  of  the  nares,  without  any 
evidence  even  that  it  had  formed  in  the  esophagus, 
this  young  woman  was  about  to  die.  At  two  o’clock 
in  the  afternoon  of  the  Saturday  her  mind  was  per¬ 
fectly  clear,  her  strength  such  that  she  had  to  be  ad¬ 
monished  not  to  use  it.  When  it  was  proposed  to  do 
anything,  to  look  at  her  throat,  for  example,  she  would 
jump  to  sit  up  in  bed.  This,  of  course,  we  forbade. 
There  was  a  blueness  over  the  whole  surface  of  the 
body ,  and  yet  the  pulse  was  not  very  feeble.  Her 
pulse  did  not  give  warning  of  what  was  to  come  in 
live  hours,  and  yet  in  that  time  she  was  dead.  She 
did  not  die  of  dyspnoea.  She  did  not  die  of  the  direct 


Description. 


33 


effects  of  inflammation  in  her  throat,  but  of  diptheritic 
poison,  operating  in  some  way  or  another  apparently 
to  prevent  the  free  aeration  of  the  blood,  and  how  that 
could  be  I  do  not  know — perhaps  by  some  paralyzing 
influence  on  the  pneumogastric  nerve. 

“  A  beautiful  girl,  four  or  five  years  of  age,  had  an 
exudation  on  her  tonsils  which  was  at  first  treated  by 
repeated  application  of  a  strong  solution  of  nitrate 
of  silver;  afterward  by  milder  local  applications,  as 
chlorate  of  potassa.  She  had  but  little  fever,  and 
maintained,  for  the  most  part,  a  fair  appetite.  She 
was  most  of  the  time  cheerful  and  playful,  though 
almost  wholly  kept  in  bed  as  a  measure  of  prudence. 
The  membrane  forming  in  successive  layers  on  the 
tonsils,  lasted  twenty  days,  as  I  have  said,  without  ex¬ 
tending  to  the  air-passages  or  the  nostrils.  From  the 
sixteenth  day,  she  lost  her  relish  for  food.  On  the 
eighteenth,  the  pulse  began  gradually  to  increase  in 
frequency  without  heat  of  skin,  and  without  any  dis¬ 
coverable  cause  advancing  from  eighty-five  in  the 
minute  to  ninety-five,  one  hundred,  one  hundred  and 
ten.  The  next  day  it  increased  still  in  frequency  to 
one  hundred  and  twenty,  to  one  hundred  and  thirty, 
and  one  hundred  and  forty ;  and  on  the  third  day  of 
this  acceleration,  she  died  as  the  fire  dies  out  for  want 
of  fuel.  There  was  not  the  slightest  dyspnoea  from 
first  to  last — no  hoarse  cough.  There  was  no  visible 
hemorrhage.55 

0.  C.  Tower,  M.D.,  of  South  Weymouth,  Mass.,  in 
the  Boston  Medical  and  Surgical  Journal ,  March  7, 
1861,  thus  describes  the  disease  as  it  prevailed  in  his 
immediate  vicinity,  amounting  in  all  to  seventy  cases 
and  sixteen  deaths  :  “  The  patient  generally  feels  some¬ 
what  unwell’ for  a  day  or  two  before  the  affection  of 

2* 


34 


Diptheria. 


the  throat  is  manifest.  His  appetite  fails.  Perhaps 
nausea  and  vomiting  are  the  first  symptoms.  Adults 
complain  of  chilliness  and  aches  in  their  limbs.  If  a 
child,  he  loses  his  inclination  to  play,  and  is  inclined 
to  be  drowsy.  There  may  be  restlessness  at  night, 
gritting  of  the  teeth,  and  feverishness.  Hot  unfre- 
quently  none  of  these  precursory  signs  appear,  and  if 
any  of  them  occur,  they  are  not  thought  of  at  the  time, 
but  are  recalled  to  mind  by  the  patient,  or  the  parents 
of  the  child,  after  the  more  patent  symptoms  set  in. 
On  the  second  or  third  day,  if  not  before,  there  is  ob¬ 
served  some  difficulty  in  deglutition,  and  externally 
may  be  felt  slight  enlargement  of  one  or  both  sub¬ 
maxillary  glands,  which  are  tender  on  pressure.  Per¬ 
haps  the  first  thing  noticed  by  the  parents  of  the  child 
is  the  swelling  of  the  areolar  tissue  of  the  throat.  At 
this  period,  examination  of  the  fauces  generally  reveals 
swelling  of  one  or  both  of  the  tonsils  and  soft  palate, 
accompanied  with  unusual  redness  of  the  mucous 
membrane.  Small  patches  of  membranous  lymph,  of 
a  dirty- whitish  color,  are  also  visible.  I  have  detected 
this  deposit  when  it  was  no  larger  in  extent  than  a 
split  pea,  but  usually  it  is  as  large  as  a  three-cent 
piece.  I  have  been  first  called  to  attend  a  patient 
when  the  whole  fauces  and  soft  palate  were  covered 
with  this  exudation.  Parts  of  the  pharynx  not  cov¬ 
ered  with  this  false  membrane  are  usually  edematous 
and  fiery  red,  resembling  erysipelas. 

“  Prom  this  period  the  symptoms  rapidly  increase  in 
severity,  if  not  arrested.  At  the  expiration  of  a  week 
the  prognosis,  whether  favorable  or  otherwise,  can  be 
determined.  Death  usually  occurs  between  the  end 
of  the  first  and  second  week. 

“  The  swelling  of  the  throat  in  severe  cases  is  very 


Description. 


35 


great,  so  as  to  interfere  with,  tlie  venous  circulation, 
thus  producing  a  bloated  and  dusky  aspect  of  the 
countenance.  Breathing  becomes  laborious,  causing 
the  head  to  be  thrown  backward.  The  skin  is  moist, 
often  bathed  in  perspiration.  The  pulse  is  rapid,  soft, 
and  small.  Speech  becomes  lost,  or  audible  only  in 
whisper.  The  strength  rapidly  fails.  Expectoration, 
at  the  end  of  a  week,  is  quite  profuse.  Large  flakes 
of  fibrine,  perfect  castings  of  the  air-passages,  may  be 
expelled  by  coughing. 

“  There  is  an  odor,  characteristic  of  this  throat  affec¬ 
tion,  sometimes  so  intense  as  to  pervade  the  whole 
apartment. 

“  Death  usually  occurs  from  exhaustion  of  the  vital 
forces.  Frequently  the  little  patient  lies  several  hours 
in  a  half  comatose  state  before  life  ceases.  There  is 
much  suffering  from  dyspnoea  in  severe  cases,  when 
symptoms  of  croup  manifest  themselves. 

“  Starting  at  the  pharynx,  this  disease  extends  up¬ 
ward  into  the  nasal  openings  of  the  frontal  sinuses, 
backward  into  the  eustachian  tubes,  and  downward 
into  the  trachea  and  bronchi,  and,  as  I  have  reason  to 
believe,  into  the  alimentary  tract.” 

Professor  George  B.  "Wood,  M.D.,  of  Philadelphia 
(Wood’s  Practice  of  Medicine),  who  treats  of  diptheria 
under  the  name  of  pseudo-membranous  inflammation 
of  the  fauces ,  has  very  well  collated  and  arranged  the 
symptoms,  as  they  are  manifested  in  the  great  majority 
of  cases :  u  The  disease  commences  with  some  redness 
of  the  fauces  and  uneasiness,  such  as  occur  in  ordinary 
sore  throat,  but  usually  in  a  less  degree.  This  condi¬ 
tion  lasts  but  a  very  short  time  before  the  exudation 
commences  ;  and,  when  first  seen  by  the  physician,  the 
surface  almost  always  exhibits  small,  irregularly  cir- 


8Q 


Diptiiekia. 


cumscribed,  whitish,  yellowish-white,  or  ash-colored 
patches,  sometimes  seated  in  a  portion  only  in  the 
fauces,  sometimes  scattered  here  and  there  over  almost 
their  whole  extent.  These  patches  bear  no  inconsider¬ 
able  resemblance  to  superficial  sloughs,  or  to  the  sur¬ 
face  of  ulcers,  for  both  of  which  they  have  not  unfre- 
cpiently  been  mistaken;  but  it  has  been  shown,  by  the 
most  careful  microscopic  observations,  that  they  consist 
of  a  concrete  exudation  similar  to  false  membrane,  and 
that  the  surface  of  the  membrane  beneath  them  has 
not  necessarily  undergone  any  loss  of  substance,  unless 
of  the  epithelium.  Sometimes,  however,  ulceration  is 
found  to  have  taken  place  beneath  them.  In  some 
instances  the  patches  are  translucent.  Their  consist¬ 
ence  is  various,  occasionally  pultaceous,  but  more  fre¬ 
quently  somewhat  dense  and  even  tough.  The  mem¬ 
brane  around  them  is  inflamed  and  reddened,  and  the 
tonsils  are  usually  more  or  less  swollen,  as  are  fre¬ 
quently  also  the  cervical  and  submaxillary  glands,  and 
sometimes  even  the  parotids.  Examined  by  the  micro¬ 
scope,  they  have  been  found  to  consist  mainly  of 
interlacing  fibrils,  with  molecular  granules,  epithelial 
cells  in  different  stages,  and  often  pus  or  blood  cor¬ 
puscles. 

“In  mild  cases,  such  as  often  occur  sporadically,  the 
patches  are  few,  more  regularly  circumscribed  than  in 
the  severer  forms,  and  not  disposed  to  spread ;  while 
there  is  little  tumefaction  either  of  the  tonsils  or  the 
external  parts,  and  little  or  no  fever.  They  are  apt, 
however,  to  be  attended  with  much  pain  in  swallowing. 
In  the  severer  cases,  the  patches  spread  with  greater 
or  less  rapidity,  sometimes  in  the  course  of  a  few 
hours  coalescing  and  covering  the  whole  fauces,  but 
more  frequently  advancing  rather  slowly,  and  leaving 


Description. 


37 


portions  of  the  membrane  uncovered.  There  is  com¬ 
monly  more  of  the  exudation  on  one  side  than  on  the 
other ;  and  on  that  where  it  is  more  abundant  the 
swelling  of  the  tonsils  and  external  parts  is  greatest. 
The  deglutition  now  becomes  more  difficult,  and 
liquids  often  return  by  the  nostrils  in  attempts  to 
swallow.  The  patches,  soon  after  they  are  completely 
formed,  begin  to  be  removed,  sometimes  separating  in 
strips,  sometimes  softening  and  mixing  with  the  fluids 
of  the  mouth,  and  in  a  few  cases  disappearing  by 
absorption.  They  are  often  renewed,  occasionally 
several  times,  each  time  becoming  whiter  and  thinner, 
till  at  length  they  leave  the  surface  covered  with  a 
puriform  mucus.  The  process  of  separation  usually 
lasts  eight  or  ten  days.  ( Guemset .)  During  its  pro¬ 
gress,  it  is  attended  with  the  discharge  of  some  blood 
and  copious  vitiated  secretions,  which  occasion  much 
hawking  and  spitting,  and  hence  a  very  offensive  odor. 
There  is  often  also  a  flow  of  extremely  fetid  sanies 
from  the  nostrils,  indicating  the  extension  of  the  disease 
to  the  nasal  passages.  The  odor  of  the  discharges  in 
these  cases  has  tended  to  confirm  the  erroneous  idea 
that  the  disease  is  essentially  gangrenous.  In  the 
course  of  the  complaint,  the  disposition  to  exudation 
often  travels  downward,  and  the  larynx,  trachea,  and 
even  bronchia  become  lined  with  false  membrane, 
which  obstructs  respiration,  and  often  leads  to  fatal 
results.  This  extension  of  the  disease  constitutes,  in¬ 
deed,  its  chief  danger.  It  may  come  on  at  any  period, 
from  the  first  appearance  of  the  patches  to  the  seventh 
or  eighth  day,  and  is  indicated  by  those  changes  in  the 
voice  and  respiration  which  characterize  pseudo-mem¬ 
branous  croup.  A  distinguishing  characteristic  of  this 
diptheritic  affection,  showing  that  it  is  connected  with 


38 


Diptheria. 


tlie  state  of  tlie  system  at  large,  or  of  the  blood,  is 
that  it  is  disposed  to  appear  on  most  other  surfaces 
which  may  be  excoriated  or  suppurating.  The  mu¬ 
cous  membranes  to  which  the  air  has  access,  and  the 
skin,  are  peculiarly  liable  to  be  affected ;  but  the  mu¬ 
cous  lining  of  the  stomach  and  bowels  is  remarkably 
exempt.” 


PATHOLOGY  OF  DIPTHERIA. 

I  employ  the  phrase,  pathology  of  diptheria,  in  def¬ 
erence  to  “  established  usage,”  rather  than  in  obedience 
to  scientific  propriety.  The  “  pathology  of  disease,” 
though  an  expression  very  frequently  occurring  in 
medical  literature,  is  as  nonsensical,  considered  in  the 
light  of  true  science,  as  is  another  technicality  quite  as 
commonly  found  in  the  medical  phraseology  of  the 
day,  to  wTit,  the  “  physiological  effects  of  medicines.” 
When  it  is  considered  that  medicines  are  confessedly, 
in  their  relations  to  the  vital  organism,  absolute  poi¬ 
sons,  the  absurdity  of  the  word  u  physiological”  is 
sufficiently  manifest.  And  when  it  is  understood  that 
disease  is  pathology  and  pathology  is  disease,  the 
pathology  of  disease  must  be  regarded  as  something 
akin  to  a  “  rhetorical  flourish”  or  a  u  glittering  gen¬ 
erality.” 

But  medical  technology  must  of  necessity  be  in  har¬ 
mony  with  the  doctrines  on  which  it  is  predicated; 
and  if  these  are  false,  the  nomenclature  of  the  so-called 
science  can  be  nothing  more  nor  less  than  technical 
gibberish — the  u  incoherent  expressions  of  incoherent 
ideas.” 

And  now  it  so  happens  that  the  medical  profession 
does  entertain  and  teach — as  I  have  shown  in  other 
works — a  false  doctrine  of  the  nature  of  disease ;  a 


Pathology. 


39 


false  doctrine  of  the  action  of  medicines  ;  a  false  theory 
of  vitality ;  a  false  doctrine  of  the  law  of  cure  ;  a  false 
doctrine  of  the  relations  of  remedies  to  diseases  ;  a  false 
doctrine  of  the  relations  of  remedies  to  the  living  or¬ 
ganism  ;  a  false  doctrine  of  the  relations  of  disease  to 
the  living  system ;  and  a  false  theory  of  the  vis  medi - 
catrix  naturae;  and  these  facts  necessitate  a  false 
technology. 

The  term  pathology,  when  applied  to  disease,  should 
he  superseded  by  the  word  nosology ,  as  this  means  the 
classification  and  arrangement  of  disease — the  relation, 
so  far  as  morbid  conditions  and  actions  are  concerned, 
of  one  disease  to  another.  If  one  should  employ  the 
term  diseaseology ,  or  the  phrase,  the  disease  of  disease , 
or  the  pathology  of  pathology ,  he  would  be  accused 
of  misusing  language  very  nonsensically ;  yet  these 
phrases  are  not  a  whit  more  absurd — not  to  say  ridicu¬ 
lous — than  are  one  half  of  the  technicalities  to  be  found 
in  medical  books. 

A  good  illustration  of  this  subject  is  found  in  the 
writings  on  materia  medica  and  therapeutics.  For  ex¬ 
ample,  Pereira,  in  his  elaborate  work  (Materia  Medica 
and  Therapeutics),  under  the  head  of  the  Physiological 
Effects  of  Corrosive  Sublimate,  says  :  “  When  growing 
plants  are  immersed  in  a  solution  of  this  salt,  a  part 
of  \h.Q  poison  is  absorbed,  a  change  of  color  takes  place 
in  the  leaves  and  stem,  and  death  is  produced P  Is 
not  death  a  queer  “  physiological”  result  ?  I  venture 
the  opinion  that  no  man  alive,  whose  reasoning  powers 
in  relation  to  medical  subjects  had  never  been  twisted, 
distorted,  perverted,  subverted,  introverted,  and  retro- 
verted  by  a  medical  education,  would  ever  suspect  this 
result  to  be  physiological !  He  would  certainly  judge 
it  to  be  just  the  contrary — morbid,  pathological. 


40 


Diptheria. 


Pereira  says  further :  “  On  dogs,  cats,  horses,  rabbits, 
and  frogs,  experiments  have  been  tried  with  bi-chlo¬ 
ride  of  mercury,  and  it  has  been  found  to  exercise  a 
poisonous  operation.5’  And  so  its  “  physiological 
effects55  are  incomprehensible  on  animals  as  on  plants. 
It  simply  poisons  them  to  sickness  or  death,  and  this  is 
exactly  the  opposite  of  any  thing  or  process  to  which  the 
word  physiology  can  be  properly  applied. 

But  how  is  it  with  man  ?  Pereira  says  :  “  Corrosive 
sublimate  causes,  when  swallowed,  corrosion  of  the 
stomach  ;  and  in  whatever  way  it  obtains  entrance 
into  the  body,  irritation  of  that  organ  and  of  the  rec¬ 
tum,  inflammation  of  the  lungs,  depressed  action,  and 
perhaps  also  inflammation  of  the  heart,  oppression  of 
the  functions  of  the  brain,  and  inflammation  of  the 
salivary  glands.55 

If  this  be  physiological,  physiology  is  a  different 
thing  from  what  the  dictionaries  define  it  to  be.  It  is 
there  called  the  “science  of  life.55  But  medical  au¬ 
thors  would  have  it  the  process  of  death.  It  is  there 
explained  to  be  the  doctrine  of  the  normal  actions.  But 
our  medical  books  make  it  the  doctrine  of  abnormal 
conditions. 

Physiology  comprehends  simply  and  solely  the  vital 
functions  in  their  normal  exercise,  as  manifested  in  the 
nutrition,  development,  and  growth  of  the  body  ;  but 
medical  men  misapply  the  term  to  its  morbid  pro¬ 
cesses,  and  so  confound  all  distinctions  between  food 
and  poisons,  between  health  and  disease,  between  nor¬ 
mal  function  and  remedial  effect,  between  the  vis  con - 
servatrix  naturae  and  the  vis  medicatrix  naturae — in  a 
word,  between  physiology  and  pathology. 

Dunglison  tells  us  in  his  Medical  Dictionary  that 
pathology  has  been  defined  the  physiology  of  disease. 


Pathology-. 


41 


Now,  disease  has  no  physiology.  It  is  the  very  oppo¬ 
site  of  physiology.  It  is  pathological  from  first  to 
last.  It  is  disease  !  The  term,  “  disordered  physiol¬ 
ogy,”  as  employed  by  Dr.  Good  (Study  of  Medicine), 
is  appropriate,  for  it  means,  simply,  abnormal  or  mor¬ 
bid  action ,  and  this  is  pathology,  disease.  It  is  quite 
as  absurd  to  apply  the  term  physiological  to  diseases 
and  poisons  as  it  would  be  to  apply  the  term  patho¬ 
logical  to  food  and  health. 

What  is  diptheria?  Medical  writers  agree  that  it  is 
an  inflammation,  or  a  fever,  or  both  !  But  what  is  in¬ 
flammation  or  fever  ?  This  problem  the  profession  has 
not  yet  solved.  It  professes  to  understand  only  the 
forms  and  features,  the  phenomena  of  inflammation 
and  fever ;  but  of  their  real  character  or  essential  nature 
it  teaches,  and  books  confess  that  they  know,  nothing. 
And  why  should  they,  so  long  as  they  can  not  explain 
what  disease  itself  is  ? 

Says  Professor  Gross  :  “  Of  the  essence  of  disease  we 
know  very  little ;  indeed,  nothing  at  all.”  The  con¬ 
clusion  follows  by  irresistible  logic  that,  if  the  medical 
profession  can  not  understand  the  nature  of  disease  as 
such — if  it  knows  not  what  disease  is,  it  can  not  in  the 
very  nature  of  things  understand  the  nature  of  any 
particular  form  of  disease  ;  ergo ,  the  profession  knows 
nothing  of  the  essential  nature  of  diptheria,  and  this 
may  account  for  its  unsuccessful  treatment  of  the 
malady. 

The  relation  of  diptheria  to  croup  and  to  malignant 
scarlet  fever  has  been  much  discussed  through  the 
medical  journals,  some  authors  regarding  diptheria  as 
identical  with  that  form  of  scarlatina  in  which  the  ex¬ 
cretion  of  morbid  matter  is  mainly  determined  to  the 
throat,  with  little  or  no  cutaneous  eruption,  while 


42 


Diptiieria. 


others  regard  it  as  differing  from  croup  only  in  the 
fact  that  the  inflammatory  action  affects  principally  the 
mucous  membrane  of  the  throat,  instead  of  that  of  the 
trachea  or  windpipe,  as  in  the  case  of  croup. 

Whatever  may  be  true  in  theory,  the  facts  are  suf¬ 
ficiently  obvious.  It  is  true  that  in  the  cases  of  mem- 
branific  inflammation,  to  which  the  term  diptheria  is 
usually  applied,  there  is  an  exudation  of  fibrinous 
material — coagulable  lymph- — on  the  mucous  surface 
of  the  throat,  quite  analogous  and  frequently  identical 
in  character  with  that  which  takes  place  on  the  mu¬ 
cous  surface  of  the  trachea  in  croup ;  and  in  some 
cases  extending,  as  we  have  seen,  into  the  windpipe 
and  esophagus.  It  is  also  true  that  scarlatina  malig¬ 
na  is  characterized  by  ulcerative  inflammation  of  the 
throat,  instead  of  the  exudation  which  produces  the  false 
membrane.  And  it  is  equally  true,  moreover,  that  in 
some  cases  of  diptheria  ulceration  does  take  place 
beneath  the  membranous  formation,  while  in  some 
cases  of  putrid  sore  throat  there  are  patches,  more  or 
less  extensive,  of  diptheritic  or  croupal  excretion. 
For  all  practical  purposes,  therefore,  we  may  regard 
diptheria  as  combining  the  morbid  conditions  of  both 
croup  and  malignant  scarlet  fever,  one  or  the  other 
being  more  prominent  according  to  the  condition  and 
habits  of  the  patient  in  whom  the  disease  occurs. 

There  is  much  discrepancy  among  the  authors  as  to 
the  symptoms  of  diptheria  which  are  supposed  to 
identify  it  with  croup  on  the  one  hand,  or  malignant 
scarlatina  on  the  other.  Some  authors  have  noticed  a 
scarlet  eruption  of  the  skin  accompanying  the  throat- 
affection,  and  the  putrescent  condition  of  the  whole 
system,  attended  with  fetid  breath  and  foul  excretions, 
as  in  malignant  scarlet  fever ;  while  other  authors  de- 


Pathology. 


43 


scribe  it  as  being  entirely  free  of  offensiveness  and 
eruption. 

Both  sets  of  authors  are  correct  in  their  facts,  yet 
mistaken  in  their  theories.  The  disease  occurs  in  per¬ 
sons  of  very  different  dietetic  and  other  personal 
habits,  and  in  very  different  conditions  of  system,  so 
far  as  grossness  of  blood  and  exhaustion  of  vital 
power  are  concerned.  These  facts,  which  are  of  the 
utmost  importance  in  enabling  ns  to  understand  the 
rationale  of  the  various  forms  of  diptheria,  seem  to  be 
wholly  overlooked  and  unthought  of  by  the  authors 
who  have  written  on  the  subject. 

Every  febrile  disease  of  the  continued  type — and 
diptheria  is  a  continued  febrile  disease ;  that  is  to  say, 
a  local  inflammation  essentially  accompanied  with  a 
constitutional  fever — is  either  of  the  inflammatory  or 
typhoid  diathesis  ;  and  if  of  the  typhoid  diathesis  it  is 
either  of  the  putrid  or  nervous  form.  Diptheria  is 
always  of  the  atonic,  low,  or  typhoid  diathesis  ;  and 
never  attended  with  high  or  entonic  fever.  And  if  the 
condition  of  the  patient  be  very  gross,  the  disease  will 
present  the  putrid  phase  of  fever,  usually  called 
typhus ,  or  typhus  gravior  in  medical  books ;  but  if 
the  patient  be  in  a  less  gross  and  more  debilitated 
state,  the  disease  will  be  of  the  nervous  form,  the 
typhus  mitior  of  the  older  authors,  the  typhoid  fever 
of  modern  authors,  and  the  enteric  fever  of  Wood  and 
others. 

But  our  medical  authors  are  wholly  at  fault  as  to 
the  causes  of  these  distinctions.  They  are  usually  at¬ 
tributed  to  some  specific  property  in  the  morbific  ma¬ 
terial  which  induces  the  malady,  or  to  some  quality 
inherent  in  the  disease  itself,  as  though  this  were  a 
thing  or  entity  outside  of  the  living  organism  and 


44 


Dipthekia. 


capable  of  assuming  a  variety  of  shapes,  whereas  the 
real  cause  is  to  be  found  solely  in  the  condition  of  the 
patient.  In  some  places,  where  nearly  every  case  of 
diptheria  has  terminated  fatally,  the  disease  is  said  to 
have  been  of  a  very  malignant  type;  and  in  other 
places,  where  few  deaths  have  occurred,  it  is  said .  to 
have  been  of  a  very  mild  type ;  as  though  the  disease 
had  an  existence  and  a  character  before  it  u  attacked” 
the  living  organism. 

Such  is  the  medical  science  of  the  nineteenth  cen¬ 
tury,  but  it  is  a  delusion.  The  disease,  so  far  from 
existing  as  an  entity  outside  and  independent  of  the 
living  system,  so  far  from  being  a  thing  acting  on  or 
attacking  the  system  from  without,  is  really,  as  is 
every  other  form  of  disease,  the  action  of  the  vital 
organism  itself.  It  is  the  living  system  in  the  act  of 
expelling  impurities — a  process  of  purification.  And 
malignancy  is  determined,  both  in  nature  and  degree, 
by  the  condition  of  the  system,  and  always  exists  in 
the  exact  ratio  to  the  grossness  or  putrescency  of  the 
blood,  or  the  debility  or  exhaustion  of  the  nerves. 
When  diptheria,  therefore,  occurs  in  persons  of  so 
gross  and  putrescent  a  condition  of  blood  as  to  induce 
the  putrid  form  of  fever,  the  breath  of  the  patient  may 
be  very  fetid,  and  the  discharges  very  offensive,  and 
the  odor  of  the  patient’s  room  very  disagreeable ; 
while,  if  the  disease  occurs  in  persons  of  a  feeble  but 
not  gross  condition,  although  it  may  be  equally  malig¬ 
nant  and  equally  fatal,  it  will  have  none  of  the  pecu¬ 
liar  evidences  of  putrescency  of  the  fluids  which 
characterize  the  other  form. 

Diptheria,  putrid  sore  throat,  and  croup,  though 
usually  distinct  in  diagnosis,  may  run  into  each  other, 
as  it  were,  by  such  imperceptible  gradations  that  it  is 


Pathology. 


45 


sometimes  difficult  to  draw  the  line  of  demarcation 
and  tell  where  one  ends  and  the  other  begins,  dip¬ 
theria  holding  the  intermediate  relation,  and  combining 
in  itself  more  or  less,  in  different  cases,  the  conditions 
of  exudation  and  ulceration  ;  while  croup  and  putrid 
sore  throat  represent,  more  distinctly,  the  membranous 
and  the  ulcerous  forms  of  inflammation,  as  it  is  pre¬ 
sented  in  a  low  atonic  or  putrescent  state  of  the 
system. 

Some  authors  have  seemed  to  confound  diptheria 
with  quinsy — tonsillitis',  but  in  .the  latter  case  the 
swelling  and  redness  of  the  tonsils,  with  difficult 
deglutition  at  the  outset,  and  the  absence  of  all  evi¬ 
dences  of  fibrinous  exudation,  are  sufficient  to  enable 
the  careful  observer  to  distinguish  between  them. 

Authors  have  disagreed  also  respecting  the  febrile 
or  non-febrile  character  of  diptheria ;  and  we  are 
gravely  assured  by  some  authors  who  profess  to  have 
had  much  experience,  that  it  is  scarcely  ever  febrile ; 
while  other  authors  as  gravely  talk  of  the  disease 
“  becoming  typhoid,”  or  of  “  typhoid  symptoms  super- 
'  vening.”  The  truth  is,  the  disease  is  always  febrile, 
as  are  all  acute  visceral  inflammations,  although,  in 
many  cases,  as  in  all  visceral  inflammation  of  low 
diathesis,  the  hot  stage  of  the  febrile  paroxysm  may  be 
very  slight  and  scarcely  observed  at  all,  or  entirely 
overlooked.  And  the  fever  is  always  typhoid  from 
first  to  last,  so  that  the  phrases  “  running  into  typhoid,” 
“  typhoid  supervening,”  etc.,  indicate  an  erroneous 
view  of  the  character  of  the  malady. 

The  following  article  appeared  not  long  since  in  the 
New  York  Commercial  Advertiser ,  and  it  represents 
very  well  many  errors,  both  in  pathology  and  thera¬ 
peutics,  which  are  entertained  by  the  great  majority 


46 


Diptheria. 


of  the  medical  profession.  I  copy  it  for  the  oppor- 
tunity  it  affords  for  corrective  criticism. 

“  This  disease,  though  in  many  respects  resembling 
croup — and  in  certain  others,  quinsy — is  distinguish¬ 
able  from  both  by  certain  well-marked  characteristics. 
Like  croup,  it  is  accompanied  by  the  formation  of  a 
false  membrane  in  the  windpipe,  which,  if  left  to  itself, 
accumulates  till  the  air-passage  is  closed  and  death 
ensues.  But  the  false  membrane  of  croup  is  an 
exudation  of  natural  lymph  from  the  vessels  of  the 
mucous  membrane  stimulated  to  excess  by  high  febrile 
condition  of  the  tissue ;  while,  on  the  other  hand, 
diptheria  is  scarcely  ever  febrile  in  its  pathology — and 
its  pseudo-membrane  is  the  result  of  a  sloughing  off 
rather  than  an  exudation  of  the  mucous  coating. 
Croup  belongs  to  the  inflammatory  type  of  diseases — 
diptheria,  save  in  exceptional  cases,  does  not.  In 
croup,  the  breath  of  the  patient  is  usually  untainted. 
In  diptheria,  the  breath  is  characterized  by  a  peculiar 
and  sometimes  almost  intolerable  fetor.  The  lymphatic 
discharges  of  croup  are  seldom  acrid.  The  discharges 
from  the  nose  and  mouth  of  a  diptheritic  patient  are 
ichorous  and  excoriating  to  the  highest  degree.  Croup 
is  not  particularly  prostrating  to  the  general  strength 
of  the  person  attacked  by  it.  Diptheria  is  invariably 
accompanied  by  extreme  debility,  and  a  loss  of  mus¬ 
cular  as  wTell  as  nervous  tone,  which  often  continues 
for  months  after  the  immediately  dangerous  symptoms 
have  been  overcome.  Finally,  diptheria  is  contagious 
• — croup  is  not. 

“  It  will  be  seen  from  these  details  that  diptheria  and 
quinsy  have  more  intimate  points  of  resemblance  than 
diptheria  and  croup.  In  certain  cases  this  resemblance 
is  greatly  increased  by  a  complication  of  the  pseudo- 


Pathology. 


47 


membranous  symptom  of  diptheria  with  malignant 
inflammation  of  tlie  tonsils.  Still  the  pseudo-mem¬ 
branous  symptom  is  of  course  always  sufficient  to  dis¬ 
tinguish  it  from  quinsy. 

“  It  is  not  probable  that  diptheria  is  a  new  disease. 
The  scientific  accuracy  of  medical  terms  has  made  such 
rapid  progress  during  the  last  half  century,  that  the  phy¬ 
sicians  frequently  find  the  data  of  diseases,  as  reported 
thirty  years  ago,  unavailable  through  vagueness  for 
the  purposes  of  an  indicative  experience,  neverthe¬ 
less,  from  all  that  can  be  ascertained  on  the  subject, 
the  identity  of  diptheria  with  the  “  putrid  sore  throat,” 
which  made  such  fearful  ravages  in  Albany  and  other 
places  a  quarter  of  a  century  ago,  seems  very  probable. 
That  malady  was  characterized  by  marked  typhoid 
symptoms,  and  this  indication  has  its  counterpart  in 
the  extreme  prostration  of  diptheria.  If  we  recollect 
rightly,  not  a  single  case  of  the  old  putrid  sore  throat, 
which  received  the  then  universal  depleting  treatment 
of  calomel  and  blood-letting,  ever  recovered  from  the 
disease.  At  the  present  day,  nobody  in  his  senses 
would  think  of  letting  blood  or  giving  exhaustive  med¬ 
icine  for  diptheria. 

a  The  treatment  of  the  disease  proposes  to  itself  two 
ends : 

“  1st.  To  evoke  and  sustain  all  the  natural  vital 
forces  of  the  patient. 

“  2d.  To  rid  the  air-passages  of  the  false  membrane. 

“  For  the  attainment  of  the  first  end,  nutritious, 
digestible  food ,  being  the  most  natural,  is,  of  course, 
also  the  best  means.  Strong  beef  tea  combines  all 
the  most  desirable  elements  for  such  a  purpose.  It 
should  be  given  from  the  earliest  stages  of  the  disease  ; 
and  when,  as  sometimes  happens,  the  fauces  become 


48 


Diptiiekia. 


closed  by  tlie  disease,  or  the  parts  become  too  painful 
to  admit  of  swallowing,  it  is  still  to  be  given  in  the 
form  of  anal  injections.  Brandy,  in  judicious  hands, 
is  another  stimulus  of  the  highest  value  in  diptheria. 
Iron  in  various  forms  has  been  administered  with 
great  success.  Perhaps  its  most  efficient  form,  as 
determined  by  late  experience,  is  the  sesquioxide.  Its 
effect  seems  to  be  two-fold — sustaining  the  general 
strength  of  the  patient,  and  assisting  the  tendency  of  the 
mucous  membrane  to  throw  off  and  eject  the  diptheritic 
slough. 

“  For  the  attainment  of  the  second  end  innumerable 
methods  have  been  proposed,  and  some  of  them  have 
been  very  successful.  Occasionally  the  use  of  the 
sesquioxide  above  mentioned  has  been  successful,  in 
co-operation  with  the  forces  of  FTature,  to  produce  the 
rejection  of  the  membrane  as  fast  as  it  accumulated 
and  before  it  was  indurated  sufficiently  to  exclude  all 
air  from  the  lungs.  Sometimes  it  has  been  found 
possible  to  detach  and  pull  out  the  membrane  by 
means  of  a  hooked  or  forcep-sliaped  instrument,  though 
this  operation  has  been  known  to  result  in  dangerous 
hemorrhage.  But  by  far  the  most  successful  treat¬ 
ment  for  relieving  the  diptheritic  patient  of  the  false 
membrane  is  that  recently  discovered  by  Dr.  Lewis 
A.  Sayre,  of  this  city.  Iiis  method  is  one  of  those 
admirable  attainments  of  the  highest  class  of  inventive 
genius  which,  from  their  extreme  simplicity  and 
obviousness,  awaken  in  every  mind  the  remark — 
‘Why,  I  might  have  thought  of  that  myself!’  Yet 
nobody  ever  does  think  of  it  till  the  inventive  genius 
happens  to  show  him  the  way. 

“  The  method  of  Dr.  Sayre  was  the  result  of  the  fol¬ 
lowing  observation.  He  noticed  that  if  the  discharge 


Pathology. 


49 


of  diptlieria  was  expectorated  upon  any  dry  and  warm 
substance — sucli  as  the  side  of  a  stove,  for  instance — 
it  immediately  became  a  tough  pellicle,  like  a  shred 
of  gold-beaters’  skin.  But  if  the  expectoration  fell  into 
a  vessel  containing  warm  water,  it  remained  liquid  and 
limpid,  like  ordinary  thin  lymph  or  mucus. 

“  It  now  occurred  to  Dr.  Sayre,  that  if  from  the  first 
stages  of  the  formation  of  the  false  membrane  a  hot 
and  humid  atmosphere  could  be  kept  in  contact  with 
it,  it  would  remain  as  soluble  as  in  this  last-mentioned 
case,  and  be  easily  ejected  through  the  nose  and  mouth 
like  common  mucus. 

“  Several  means  of  procuring  this  contact  suggest 
themselves.  The  well-known  plan  of  inhalation  from 
the  spout  of  a  tea-kettle,  and  the  ordinary  vapor-bath, 
are  among  these.  But  the  former  is  evidently  imprac¬ 
ticable  with  those  young  children  who  are  the  most 
frequent  sufferers  from  diptheria.  They  can  not  be 
made  to  keep  their  mouths  in  position  over  the  narrow 
steam  surface  of  a  kettle.  The  vapor-bath  is  relaxing 
to  the  general  system,  and  can  not  be  thought  of  in  a 
case  which,  like  diptheria,  requires  every  tonic  and 
stimulant  that  can  be  made  available.  Moreover,  it 
would  be  manifestly  impossible  to  continue  the  patient 
in  a  vapor-bath  through  a  period  as  long  as  the  mem¬ 
brane  is  accumulating. 

“  Dr.  Sayre  finally  adopted  this  method.  Having 
put  the  patient  in  a  tightly  shut  room,  he  had  a  flat-iron 
heated  to  as  near  the  white  heat  as  possible.  He  sus¬ 
pended  it  over  a  pail  in  the  sick-room,  and  kept  the 
attendants  pouring  water  on  it  till  it  ceased  to  evapo¬ 
rate  every  drop  that  came  in  contact  with  it.  As  soon 
as  the  iron  was  cooled  down  to  such  a  degree  that  any 
surplus  of  water  remained  unevaporized,  he  replaced 

3 


50 


Diptheria* 


it  with  one  freshly  heated.  He  thus  kept  the  room  as 
full  of  steam  as  was  consistent  with  comfortable 
breathing — at  a  temperature  of  80°  F.  This  process 
was  continued  for  several  hours ;  during  which  not 
only  the  freshly  sloughed  membrane  was  constantly 
being  expelled  in  liquid  form  through  the  nose  and 
mouth,  but  membrane  previously  indurated  in  the 
trachea  became  soluble  and  was  ejected  in  like  man¬ 
ner.  Meanwhile  he  kept  up  the  strength  of  the 
patient  by  the  above  referred  to  means  of  beef  and 
brandy. 

“  The  result  of  this  treatment  was  an  entire  expul¬ 
sion  of  the  slough,  and,  eventually,  the  complete  cure 
of  a  case  which  had  previously  been  abandoned  as 
too  desperate  for  even  the  dernier  operation  of  tra¬ 
cheotomy. 

“Undoubtedly  the  means  of  evaporation  for  this 
purpose  will  hereafter  be  simplified  by  the  discovery 
of  the  method.  He  has  plans  at  present  under  con¬ 
sideration  by  which  the  process  may  go  on  independ¬ 
ently  of  the  laborious  and  sometimes  unreliable  co¬ 
operation  of  attendants.  Still,  it  is  now  a  fixed  fact 
that  we  have  made  the  great  and  conclusive  step 
toward  a  certain  cure  of  diptheria.  Also,  that  we 
owe  that  fixed  fact  to  Dr.  Sayre. 

“  The  utmost  care  of  the  patient  for  weeks  after  the 
immediately  dangerous  symptoms  have  disappeared,  is 
necessary  to  prevent  a  subsidence  into  the  diptheritic 
state.  Even  where  there  is  no  return  of  the  sloughing 
tendency,  the  general  prostration  of  the  system  is  usu¬ 
ally  so  extreme,  that  the  most  nourishing  tonics  and 
stimulant  treatment  are  called  for  to  ward  off  a  natural¬ 
ly  supervening  attack  of  typhoid  or  low  nervous  fever, 
rapid  decline,  or  chronic  debility.  There  is  perhaps 


Pathology. 


51 


no  form  of  disease  known  to  the  children’s  practi¬ 
tioner  in  which,  skillful  hygiene  and  home-treatment 
are  more  imperatively  demanded  to  follow  up  and  per¬ 
petuate  the  results  of  medical  effort.  If  possible,  the 
greatest  care  must  also  be  taken  during  the  period  of 
fetid  discharges  to  separate  the  remaining  children  of 
a  family  from  the  diseased  one,  for,  as  we  have  above 
observed,  this  stage  of  the  disease  is  quite  infectious. 

“We  notice  that  diptheria  is  again  beginningto  man¬ 
ifest  itself  as  an  epidemic  in  some  of  the  rural  districts 
of  Hew  York  and  the  neighboring  States.  The  words 
we  have  said  may  be  of  still  more  use  in  a  city  like 
ours,  where  life  is  so  closely  packed,  infection  and 
death  so  easy.  But  of  these  latter  evils  there  is  no 
need.  Cure  is  now  measurably  simplified — prevention 
simpler  still.”* 

“  Diptheria  is  scarcely  ever  febrile  in  its  pathology.” 
On  the  contrary,  diptheria  is  always  febrile  in  its 
pathology.  “  Croup  belongs  to  the  inflammatory  type 
of  diseases ;  diptheria,  save  in  exceptional  cases,  does 
not.”  Both  croup  and  diptheria  are  always  inflamma¬ 
tory  and  always  febrile ,  each  disease  consisting  essen¬ 
tially  in  a  local  inflammation  and  a  constitutional 
fever.  So  far  as  inflammatory  type  is  concerned,  the 
wTord  is  misapplied.  Type,  when  properly  employed, 
pertains  to  the  periodicity  of  the  febrile  paroxysms,  as 
the  continued  remittent  and  intermittent  types  of  fever, 
and  not  to  the  entonic  or  atonic  diathesis  which  char¬ 
acterizes  them,  nor  to  the  inflammatory  or  non-inflam- 
matory  nature  of  a  disease.  The  terms  type  and 
diathesis  are  employed  quite  promiscuously  by  modern 
medical  writers,  as  are,  indeed,  a  hundred  other  teeh- 

*  In  the  above  article  are  many  errors,  both  theoretical  and  prac¬ 
tical. 


52 


Diptheeia. 


nical  words  and  phrases,  hut  it  is  for  want  of  clear 
and  correct  ideas.  ,_>■ 

The  breath  and  discharges  are  generally  more  or  less 
fetid  and  acrid  in  diptheria,  as  already  remarked,  ac¬ 
cording  to  the  greater  or  less  grossness  or  putrescency 
of  the  patient ;  hut  in  some  cases  which  I  have  seen, 
these  symptoms  were  entirely  wanting,  while  there  are 
cases  of  true  croup  in  which  the  excretions  are  foul 
and  offensive. 

“  Croup  is  not  particularly  prostrating  to  the  general 
strength  of  the  person  attacked  by  it.”  Such  language 
indicates  the  false  notion  which  the  medical  profession 
entertains  of  the  nature  of  disease — an  error  which  I 
have  been  combating  in  books  and  in  lectures  for  a 
dozen  years,  and  which  I  have  made  a  prominent 
topic  in  all  of  my  works  and  writings.  But  as  the 
limits  of  this  work  will  not  permit  me  to  discuss  the 
subject  at  length,  I  can  only  refer  the  reader  to  my 
large  book,  the  “  Hydropathic  Encyclopedia,”  and  to 
some  of  my  smaller  works,  particularly  “Water-Cure 
for  the  Million,”  Principles  of  Hygeio-Therapy,” 
and  “The  Alcoholic  Controversy,”  for  a  full  exposition 
of  the  theory  involved. 

The  idea  that  diptheria  “  prostrates  the  person  at¬ 
tacked,”  implies  that  the  disease  is  a  separate  and  dis¬ 
tinct  entity  from,  and  an  existence  outside  of  the  living 
organism  ;  and  this  absurd  theory  is  the  basis  of  all 
the  false  medical  science  and  bad  medical  practice  in 
the  world.  The  truth  is,  disease — all  disease — is  sim¬ 
ply  the  action  of  the  living  system  in  self-defense — a 
process  of  purification — a  remedial  effort.  When  this 
action  occurs,  when  this  struggle  begins,  the  system 
may  be  in  a  condition  of  great  obstruction  or  of 
extreme  exhaustion,  corresponding  with  and  occasioned. 


Pathology. 


53 


by  the  personal  habits,  manner  of  life,  occupation, 
exposures,  etc.,  of  the  patient ;  and  the  form  (not  type) 
of  the  disease  will  be  putrid  or  nervous,  as  one  or  the 
other  of  these  conditions  is  most  prominent,  and  its 
form  or  tendency  (not  type)  will  be  mild  or  malignant, 
not  according  to  some  imaginary  specific  character  of 
the  morbid  entity,  or  what  authors  so  vaguely  denomi¬ 
nate  u  epidemic  constitution,”  but  according  to  the 
greater  or  less  putrescency  or  debility  of  the  system. 
When  medical  men  recognize  these  distinctions,  they 
will  have  a  much  more  rational  pathology,  and  a 
vastly  more  successful  practice. 

“  The  loss  of  muscular  as  well  as  nervous  tone,”  and 
the  numerous  sequelae,  in  the  shape  of  chronic  diseases, 
which  so  generally  follow  the  “  attack”  of  diptheria, 
are,  in  my  opinion,  chiefly  the  effects  of  the  drug- 
remedies — in  other  words,  drug-diseases. 

So  far  as  the  treatment  recommended  in  the  preced¬ 
ing  article  is  concerned,  I  will  merely  remark  in  this 
place  that  there  are  some  things  in  it  to  commend  and 
some  to  condemn,  reserving  the  further  discussion  of 
the  matter  until  I  come  to  consider  the  therapeutic 
application  of  the  principles  I  shall  endeavor  to  estab¬ 
lish. 

Dr.  Wood  remarks:  “In  good  constitutions  the 
fever  is  usually  sthenic ;  but  sometimes,  especially 
when  the  disease  prevails  epidemically,  it  has  a  typhoid 
or  malignant  character,  and  this  condition  of  the  sys¬ 
tem  reacts  on  the  local  affection .”  The  expression  which 
I  have  italicized  is  utter  nonsense.  The  constitutional 
affection  or  condition  does  not  act  nor  react  on  the 
locai  affection,  nor  does  the  local  affection,  act  nor 
react  on  the  constitutional  condition.  The  local  affec¬ 
tion  is  an  inflammation,  and  the  constitutional  affection 


54 


Diptheria. 


is  a  fever.  Both  together  constitute  the  disease.  The 
fever  is  never  sthenic ;  but  in  good  constitutions,  that 
is  to  say,  in  constitutions  not  very  gross  nor  very  much 
enfeebled,  for  the  reasons  already  assigned,  the  fever 
will  not  be  very  low ,  but  still  it  will  be  typhoid.  And 
the  inflammation,  in  diathesis,  always  corresponds  with 
the  fever;  hence  it  is  always  low,  passive,  atonic, 
typhoid,  asthenic. 

The  doctrine  is  everywhere  recognized  in  medical 
books,  that  a  local  inflammation  and  the  accompanying 
fever  may  be  of  opposite  diatheses,  so  that  the  reme¬ 
dies  which  are  demanded  by  the  local  condition  are 
injurious  to  the  general  system,  and  vice  versa.  This 
is  one  of  the  most  pernicious  of  the  many  fallacies  of 
a  false  medical  system,  as  it  inevitably  involves  the 
practitioner  in  the  inexplicable  muddle  of  “  indications 
and  contra-indications,”  and  necessitates  the  adminis¬ 
tration  of  remedies  of  the  most  conflicting  “ modus 
operandi ,”  and  insures  the  death  of  a  large  proportion 
of  the  patients. 

The  inflammation  and  the  fever — the  local  and  the 
constitutional  aflection — in  diptheria,  as  in  all  diseases, 
always  correspond  in  character,  in  diathesis ;  and  the 
local  affection  never  requires  that  treatment  which 
aggravates  the  constitutional  condition,  nor  does  the 
general  system  ever  demand  any  remedy  or  plan  of 
treatment  which  is  not  also  best  for  the  local  aflection  ; 
and  wdien  it  is  understood  that  the  inflammation  of  the 
throat  and  the  fever  of  the  system  are  parts  of  one  and 
the  same  disease,  the  idea  of  one  “  reacting”  on  the 
other  is  sufficiently  absurd. 

Dr.  Wood  remarks  further:  “In  the  malignant 
cases  the  system  is  probably  under  some  poisonous 
influence,  superadded  to  that  of  the  local  affection.” 


Pathology. 


55 


Our  author  does  not  seem  to  have  the  remotest  idea  of 
any  rationale  of  malignancy.  Malignancy  does  not 
imply  any  “  superadded”  poison,  hut  a  great  amount 
or  quantity  of  poison,  or  a  feeble  organism. 

The  distinction  between  the  diptheritic  exudation 
and  apthous  sore  mouth,  or  thrush ,  is  well  explained 
by  Dr.  Wood:  “In  the  thrush,  the  white  coating 
appears  first  in  separate  points,  which  afterward 
coalesce ;  is  formed  upon  the  surface  of  the  epidermis, 
or  at  least  not  beneath  it ;  may  be  readily  removed 
without  affecting  the  integrity  of  the  mucous  mem¬ 
brane,  or  causing  the  least  hemorrhage,  and,  when 
examined  under  the  microscope,  is  found  to  contain 
abundantly  a  peculiar  fungous  plant.  The  diptheritic 
exudation  forms  in  patches,  beneath  the  epidermis ; 
adheres  strongly  to  the  membrane,  so  that  it  can  rarely 
he  detached  without  causing  the  extravasation  of  some 
blood ;  and  under  the  microscope  exhibits  the  ordinary 
constituents  of  false  membrane ;  namely,  interlacing 
fibrils,  molecules  or  granules,  and  exudation  or  pus 
corpuscles.  The  exudation  in  scarlatina  occurs  gener¬ 
ally  first  in  points,  like  the  thrush,  is  much  less  cohe¬ 
sive  than  the  diptheritic,  less  adherent  to  the  mucous 
membrane,  much  less  disposed  to  spread  into  the 
larynx,  and  also  less  disposed  to  make  its  appearance 
upon  surfaces  elsewhere  that  may  be  excoriated.” 

Dr.  McDonald,  of  Bristol,  Eng.  {Braithwaitd s  Ret¬ 
rospect,  Jan.,  1860),  says,  in  relation  to  the  identity 
of  diptheria  and  malignant  scarlet  fever  :  “  There  has 
been  considerable  confusion  with  respect  to  scarlet 
fever  and  diptheria.  Some  have  contended  for  the 
identity  of  the  two,  maintaining  that  those  cases  in 
which  no  rash  appeared  were  to  he  considered  as  ‘  sup¬ 
pressed  scarlet  fever.5  To  combat  this  view,  it  wil]  he 


56 


PlPTHERlA. 


sufficient,  I  think,  to  draw  attention  to  the  great  differ¬ 
ence  in  the  symptoms  I  have  described  from  those  of 
scarlatina,  and  to  state  the  fact  of  its  having  been  my 
painful  experience  to  have  attended  families,  some 
members  of  which  have  been  swept  off  by  scarlet 
fever  with  diptheria,  while  other  members,  who  had 
previously  suffered  from  scarlet  fever  in  a  severe  form,, 
were  now  attacked  with  true  diptheria.  That  scarla¬ 
tina  invites  diptheria  is  very  manifest,  but  that  the 
diseases  are  perfectly  distinct  and  different  is  equally 
certain.” 

In  another  article,  in  the  same  number  of  Braith- 
waite ,  J.  C.  S.  Jennings,  Esq.,  of  Malmesbury,  Eng., 
says  of  the  diptheria  as  it  appeared  under  his  observa¬ 
tion  :  “  At  the  first  outbreak  of  the  disease  no  cases  of 
scarlatina  had  appeared  in  the  neighborhood,  nor  were 
there  any  until  the  second  outbreak  during  the  month 
of  January  in  this  year,  when  a  few  cases  of  diptheria 
occurred  ;  but  scarlatina  maligna  ran  through  several 
families.  In  those  cases,  however,  in  which  the  rash 
was  well  developed  and  not  suppressed,  there  was 
little  or  no  throat  affection ;  and  vice  versa  /  and  when 
the  tonsils  were  affected,  there  was  not  the  peculiar 
leathery  exudation  of  diptheria.” 

Thomas  Ueckstall  Smith,  Esq.,  before  quoted,  in 
reference  to  the  “  type”  (diathesis)  of  diptheria,  re- 
marks  (. Braithwaite ,  part  46) :  “  Have  we  seen  this 
disease  before  ?  and  what  is  its  nature  ?  In  answer  to 
the  first  question,  I  can  say  confidently,  that  during  a 
period  of  upward  of  thirty  years’  practice  I  had  seen 
no  case  of  diptheria  until  1857.  I  had  read  Breton- 
neau’s  earlier  papers  many  years  since,  and  should 
have  recognized  the  disease  had  it  presented  itself. 
Of  its  nature  it  is  less  easy  to  speak.  It  is  evidently,  I 


Pathology. 


57 


think,  a  blood-disease,  and  not  merely  a  local  one. 
Put  what  is  the  nature  of  that  abnormal  condition  has 
yet  to  be  explained,  or,  rather,  I  fear,  has  yet  to  be  dis¬ 
covered. 

“  In  observing  the  progress  of  this  epidemic  I  have 
been  instinctively  led  to  reflect  on  the  altered  type  of 
disease  in  general.  I  have,  myself,  no  doubt  of  that 
alteration  in  the  type  of  disease,  observed  since  the 
year  1832  in  England.  Erom  that  date  there  has  been 
a  departure  from  the  old  sthenic  type,  and  this  has 
been  more  pronounced .  the  last  few  years,  until  at 
length  a  genuine  sthenic  form  of  illness  is  almost,  if 
not  quite,  unknown  among  us.  We  have,  instead,  low 
types  of  inflammation,  low  forms  of  cutaneous  dis¬ 
eases,  low  types  of  fever,  having  more  and  more  a 
tendency  to  the  remittent  form  ;  and  a  very  marked 
increase  in  localities  where  it  was  before  almost  un¬ 
known,  and  where  no  known  causes  have  arisen  to 
occasion  it,  of  intermittent  fever.  What  was  before 
a  mere  chill,  a  slight  cold,  thrown  off  with  the  first  re¬ 
action,  becomes  now  an  attack  of  ague.” 

The  explanation  of  this  change  of  diathesis ,  which 
the  author  before  us  denominates  “  type,”  is  not  diffi¬ 
cult  to  understand,  in  the  light  of  the  premises  I  have 
advanced.  The  diathesis  of  disease  always  tends  from 
high  to  low — runs  down,  so  to  speak— as  the  constitu¬ 
tional  vigor  of  the  people  declines.  The  change  is  not 
in  the  disease,  'per  s-e,  but  in  the  habits  of  the  people. 
Our  fathers  and  grandfathers,  our  mothers  and  grand¬ 
mothers,  when  they  had  inflammatory  and  febrile  dis¬ 
eases,  manifested  the  high,  active,  entonic  diathesis 
much  more  frequently  than  do  their  more  effeminate 
sons  and  daughters.  The  lower  the  vital  stamina,  the 
lower  will  be  the  diathesis,  because  the  more  feeble 

3* 


58 


Diptiieria. 


the  vital  struggle,  in  these  remedial  efforts  which  con¬ 
stitute  the  various  forms  of  fevers  and  inflammations. 
Is  it  not  strange  that  medical  men  have  so  long  looked 
in  the  wrong  direction  for  the  solution  of  this  problem  ? 

Mr.  Smith  continues  :  “We  have  abundant  evidence 
of  this  depression  of  vital  power  in  the  general  symp¬ 
toms  of  diptheria.  We  have  also  a  low  type  of  local 
inflammation  in  unison  with  the  general  type ;  but 
why  it  should  just  now  seize  the  throat  as  its  local  seat 
instead  of  showing  itself  as  boils,  carbuncles,  whit¬ 
lows,  thecal  abscess,  necrosed  bone,  and  in  kindred 
forms,  I  do  not  know.” 

Nor  will  our  author  ever  know  if  he  forever  pursues 
the  phantom-entity  which  medical  books  denominate 
disease.  The  inflammation  chooses  to  attack  the  throat ; 
it  prefers  that  as  its  seat ;  it  seizes  on  that  locality  in 
preference  to  another ;  it  elects  to  manifest  itself  in  the 
form  of  diptlieritic  exudation  instead  of  carbuncular 
ulceration !  Such  are  the  vagaries  of  learned  medical 
men !  Such  is  the  ridiculous  nonsense  which  makes 
ifp  the  chief  burden  of  medical  books,  and  which  is 
called  science !  I  am  of  opinion  that  the  whole  mys¬ 
tery  lies  in  a  false  notion  of  the  nature  of  disease,  and 
that  the  reason  why  disease  assumes  one  form  instead 
of  another  is,  because  the  living  system,  under  all  the 
circumstances,  can  best  depurate  itself  of  impurities  by 
the  actions  which  constitute  the  leading  symptoms  of 
the  existing  disease ;  or,  at  least,  can  not,  under  the 
circumstances,  make  any  other  or  different  effort.  To 
illustrate :  if  the  system  has  sufficient  power  to  de¬ 
termine  the  remedial  effort  chiefly  to  the  surface  and 
maintain  it  there,  the  fever,  or  the  inflammation,  or 
both  when  they  co-exist — the  diathesis — will  be  high, 
entonic,  inflammatory,  dynamic,  or  asthenic ;  but  if 


Pathology- 


59 


this  is  not  the  case,  if  the  system  is  too  gross  or  too 
feeble,  the  remedial  effort  will  be  directed  mainly  from 
the  surface,  and  the  diathesis  will  be  low,  atonic,  ty¬ 
phoid,  or  asthenic. 

That  diptheria  and  other  forms  of  throat  inflamma¬ 
tion  run  into  each  other,  so  to  speak,  by  imperceptible 
gradations,  is  apparent  to  all  who  have  had  much  expe¬ 
rience  in  treating  these  maladies. 

Says  Dr.  Edward  Ballard,  in  an  account  of  diptheria 
and  epidemic  sore  throat,  as  they  prevailed  in  the  par¬ 
ish  of  Islington  in  1858-’9 :  “  The  prevalence  of  sore 
throat  not  diptheritic  in  character,  during  the  past 
year,  has  been  matter  of  general  remark.  Many,  if 
not  most  of  these  throats,  exhibited  some  approach  to 
the  color  of  the  mucous  membrane  when  about  to  be¬ 
come  the  seat  of  diptheritic  exudation.  These  sore 
throats  appear  to  bear  about  the  same  relation  to  dip¬ 
theria  as  diarrhea  bears  to  cholera  in  epidemic  seasons. 
Just  as  in  any  cases  of  diarrhea,  in  an  epidemic  period, 
it  is  impossible  to  predicate  that  it  will  not  pass  into 
cholera,  if  neglected,  so,  in  the  ordinary  sore  throats 
which  have  lately  presented  themselves,  no  one  would 
be  bold  enough  to  assert  that  any  one  might  not  before 
long  exhibit  the  characteristic  symptoms  of  true  dip¬ 
theria.” 

One  more  theory  remains  to  be  considered  before 
dismissing  this  branch  of  our  subject.  Dr.  T.  Lay  cock, 
of  Edinburgh,  Scotland,  has  put  forth  the  theory 
(Br  aithwaite ,  July,  1859),  that  the  diptheritic  exuda¬ 
tion  depended  on  a  parasitic  fungus  in  the  oidium 
albicans.  This  opinion  is  undoubtedly  erroneous,  as 
Dr.  "W.  R.  Rogers  has  explained :  “  The  oidium  albi¬ 
cans  is  not  found  in  diptheritic  exudation,  unless  in 
exceptional  cases,  and  then  only  because  the  membrane 


60 


Diptiiekia. 


lias  taken  on  an  acid,  putrefying  change,  this  parasite 
requiring  an  acid,  decomposing  pabulum  whereon  to 
flourish,  as  is  well  proved  by  Berg  and  Gubler.  In 
France,  all  know  that  this  fungus  distinguishes  the 
pseudo  from  the  true  diptherite,  the  microscope  being 
its  test.  Wherever  this  oidium  is  found  it  is  muguet 
or  thrush,  plus  whatever  disease,  acute  or  chronic,  it 
may  he,  as  I  stated  in  my  paper  read  before  the  Medi¬ 
cal  Society.  I  have  only  found  the  oidium  in  one  out 
of  fourteen  specimens,  and  this  was  fifty-six  hours  after 
the  patient’s  death,  though  carefully  examined  twenty- 
four  hours  before.  I  may  add  that  the  leptothrix  hue- 
calls  mentioned  by  Dr.  Wade  is  constantly  to  he  found 
in  the  buccal  mucus  of  healthy  persons,  if  properly 
searched  for.  Dr.  Harley,  of  University  College,  lias 
stated  to  me  that  fatty  acids  are  frequently  mistaken 
for  this  fungus.  True  diptherite,  in  all  the  specimens 
I  have  examined,  is  a  granular  and  cellular  exudation, 
with  some  epithelial  mucous  corpuscles,  and  sometimes 
there  may  be  found  with  it  pus  and  blood-cells.  I 
have  but  rarely  distinguished  fibrillse,  or  what  looked 
like  these.  Under  the  exudation,  the  sub-mucous  tis¬ 
sues  and  mucous  membranes  are  usually  thickened, 
and  the  mucous  follicles  are  enlarged  and  filled  with 
the  same  matter,  which  can  be  squeezed  out,  and  from 
which  the  exudation  seems  to  be  produced  ;  but  the 
cause  of  this  change  of  mucus  into  membrane  I  do  not 
desire  at  present  to  enter  upon.” 

As  Dr.  Laycock  has  published  a  reply  to  Dr.  Rogers, 
through  the  London  Lancet  for  January,  1859,  my 
work  would  be  incomplete  without  it,  although  I  do 
not  regard  it  as  sustaining  his  position,  while  it  may 
not  be  very  interesting  to  the  reader : 

“  If  I  understand  Dr.  Rogers’  views  aright,  as  re- 


Pathology. 


61 


ported  in  tlie  Lancet  of  the  22d  inst.,  he  not  only  thinks 
diptheria  to  he  a  blood-disease  (which  seems  a  probable 
theory),  blit  that,  as  such ,  it  can  not  be  a  parasitic  dis¬ 
ease.  Comparative  pathology  teaches,  however,  that 
this  conclusion  is,  at  least,  doubtful.  The  muscardine 
(an  epizootic  disease  of  the  silkworm)  is  due  to  a  spe¬ 
cies  of  fungus  like  that  which  infests  the  potato,  called, 
after  its  discoverer,  the  Botrytis  Bassiana ,  and  the 
sporules  are  described  as  being  reproduced  in  the  blood 
of  the  insect  when  it  becomes  acid ,  while  the  filaments 
and  mycelium  appear  on  the  respiratory  surfaces — that 
is,  at  the  outlets  of  the  tracheal  tubes.  (Compare  the 
engraving  of  the  blood-appearances  in  M.  Ch.  Robin’s 
valuable  ‘Histoire  Naturelle  des  Yegetaux  Parasites,’ 
etc.)  Again,  the  fungus  of  the  common  house-fly, 
named  mycophyton  Cohnii  by  Lebert,  after  Dr.  Cohn, 
its  first  investigator,  is  a  mold  or  oidium  found  in  the 
blood,  abdomen,  and  sometimes  in  the  intestines  of  the 
insect  at  the  beginning  of  autumn.  (Lebert,  Yirchow’s 
‘  Archiv.,’  etc.,  vol.  xii.,  1857.)  Its  first  symptom  ob¬ 
served  is  a  milky  appearance  of  the  blood.  It  is  found 
in  the  blood  in  all  stages  of  development,  from  the 
simple  minute  spore,  or  cell,  to  the  full-grown  myce¬ 
lium.  It  is  found  in  like  manner  in  the  fluids  of  the 
intestines,  and  appears  externally  as  a  mold.  Flies 
thus  affected  may  be  often  seen  sticking,  with  out¬ 
stretched  wings,  to  the  window-panes,  at  the  end  of 
summer  and  beginning  of  autumn.  These  are  by  no 
means  solitary  instances  of  parasitic  blood-disease. 
Indeed,  hcemotophyta,  as  Lebert  terms  these  micro¬ 
scopic  blood-parasites,  infest  the  blood  of  several  classes 
of  insects.  References  are  given  by  Lebert  loco  citato. 
The  same  fact  also  holds  good  as  to  the  vegetable  para¬ 
sites.  The  common  wheat  bunt  attacks  the  wheat,  and 


62 


DlPTHEKlA. 


makes  it  look  and  be  sickly,  when  not  the  slightest 
trace  of  fungal  thread  can  be  found ;  yet  it  is  quite 
certain  that  something  capable  of  reproducing  the  spe¬ 
cies  is  present  at  the  time,  either  in  the  intercellular 
passages  or  protoplasm.  This  I  state  on  the  author¬ 
ity  of  Mr.  Berkley.  (‘Introduction  to  Cryptogamic 
Botany,’  1857,  p.  65.)  That  eminent  observer  is  also 
of  opinion  that  the  Botrytis  infestans  is  the  fungus 
which  is  the  cause  of  the  potato  disease.  He  says  a 
crop  may  be  seen  to  grow  in  a  few  hours  from  the  cut 
surface  of  a  diseased  potato,  even  although  the  foliage 
exhibited  no  traces  of  the  parasite ;  and  that  the  walls 
of  the  cavities  of  the  carpels  of  the  tomatoes  are  often 
covered  with  the  fungus,  though  there  is  no  communi¬ 
cation  with  the  external  air.  These  are  facts  which 
ought  to  make  us  hesitate,  at  least,  in  coming  to  the 
conclusion,  in  the  absence  of  all  inquiry,  that  a  para¬ 
sitic  disease  can  not  be  a  blood-disease  in  man.  The 
same  kind  of  objection  applies  to  the  conclusions  drawn 
from  microscopic  investigations  by  Dr.  Bogers  and 
Dr.  Harley.  A  hundred  examples  of  wheat  infected 
with  the  tilletia  caries  (the  bunt)  might  be  examined  in 
succession,  or  even  a  thousand,  and  no  fungus  detected ; 
but  that  would  obviously  be  no  proof  that  the  diseased 
condition  of  the  grain  was  not  due  to  the  parasite.  It 
would  simply  signify  that  the  diseased  grain  had  not 
been  examined  at  the  proper  stage  of  the  development 
of  the  fungus.  And  I  think  the  fact  stated  by  Dr. 
Harley  and  Dr.  Bogers,  as  to  one  of  the  twelve  cases 
they  examined,  that  the  oidium  albicans  was  developed 
twenty-four  hours  after  no  trace  of  it  could  be  found,  is 
significant  of  what  may  be,  and  I  think  is,  the  rule  in 
the  living  body — namely,  that  certain  conditions  are 
necessary  as  to  development,  food,  temperature,  and 


Pathology. 


63 


habitat,  for  the  complete  evolution  of  these  organisms. 
There  is  no  doubt  that  an  acid  condition  accompa¬ 
nies  the  production  and  growth  of  the  oidium  in  mu- 
guet,  and  of  vegetable  parasites  on  the  skin  in  skin 
diseases ;  but  it  is  not  so  clear  that  the  acid  is  the  cause 
thereof.  On  the  contrary,  wre  know  that  the  produc¬ 
tion  of  acid  is  itself  due  to  fungi,  as  in  the  acetous  fer¬ 
mentation.  Dr.  Lowe,  of  King’s  Lynn,  differs  from 
Gubler  and  others  as  to  this  acid  theory,  and  I  would 
particularly  call  Dr.  Harley’s  attention  to  the  account 
of  Dr.  Lowe’s  interesting  experimental  researches  on 
these  parasitic  fungi,  published  last  year,  in  the  trans¬ 
actions  of  the  Botanical  Society  of  Edinburgh.’  The  title 
of  Dr.  Lowe’s  paper  is  significant  of  the  caution  with 
which  microscopic  researches  should  be  made.  It  runs 
thus :  6  On  the  Identity  of  Achorion  Schonleinii  and 
other  Parasites  with  Aspergillus  Gflaucus.’  Dr.  Lowe 
believes  he  c raised’  aspergillus  glaucus  from  the  para¬ 
sitic  fungus  (the  achorion  of  a  case  of  porrigo  lupinosa, 
treated  in  the  Poyal  Infirmary  here),  and  he  got  good 
yeast  (torula  cerevisise)  from  both  the  aspergillus  and 
penecilium,  wdiich  might,  therefore,  be  got  from  the 
favus-fungus.  Dr.  Lowe  infers,  in  fact,  from  his  ex¬ 
periments,  that  all  the  fungi  which  produce  skin  dis¬ 
eases  are  referable  to  these  two  genera  which  produce 
yeast ;  and  conversely,  that  yeast  may,  under  favorable 
circumstances,  produce  skin  disease.  The  leptothrix , 
so  common  on  the  foul  tongue,  is  probably  to  be  classed 
with  these  favorable  forms.  These  statements  show,  at 
least,  how  much  is  yet  to  be  done  in  natural  history 
before  the  true  morbific  action  of  these  parasitic  fungi 
can  be  determined.  One  thing,  however,  is  certain, 
that  the  parasites  of  the  potato,  vine,  apple,  and  silk¬ 
worm,  all  prevailing  simultaneously,  are  almost  identi* 


64 


Diptheeia. 


cal  with  the  oidium  albicans ;  and  considering  how 
readily  a  slight  difference  in  the  form  of  these  minute 
organisms  may  be  induced  by  differences  in  the  food 
or  habitat,  it  is  probable  that  they  are  really  identical 
in  origin  ;  and  this  coincidence  of  spread  can  not  but 
awaken  a  strong  suspicion  as  to  the  relationship  of  the 
cause  of  diptheria  to  that  of  the  epidemics  of  the  silk¬ 
worm,  yine,  potato,  etc. 

“That  these  parasites  are  sometimes  powerful  irri¬ 
tants  of  the  living  tissues  is,  I  think,  fully  established, 
both  from  the  history  of  muguet  and  other  circum¬ 
stances.  And  although  French  writers  speak  of  pseudo 
diptherite,  the  accuracy  of  the  term  may  be  questioned, 
for  the  exudation  appears  externally  on  ulcerated  or 
exposed  surfaces  as  well  as  internally  in  both  muguet 
and  diptheria  alike.  An  interesting  case  of  vaginal 
blennorrhea,  due,  probably,  to  oidium  albicans  intro¬ 
duced  from  without,  may  be  found  in  Yirchow’s 
4  Archiv.  fur  Fhysiologie,’  vol.  ix.,  p.  466.  The  case  is 
communicated  by  Dr.  E.  Martin,  of  Jena.  The  labia 
wrere  swollen  ;  the  vagina  of  bright  red,  studded  with 
enlarged  papillae,  and  covered  with  star-like  j>atches  of 
membrane  like  those  of  the  mouth  in  muguet,  which 
were  found  to  contain  the  oidium  albicans.  A  patient 
in  the  next  bed  (both  were  puerperal  patients  in  hospi¬ 
tal)  had  subsequently  active  fever,  abdominal  tender¬ 
ness,  and  oidium  albicans  of  the  mouth,  with  muguet. 
Dr.  Jos.  Ebert,  of  Wurtzburg,  found  the  oidium  albi¬ 
cans  in  the  crop,  stomach,  and  intestinal  canal  of  a 
hen.  The  upper  portion  of  the  latter  wms  intensely 
red. 

“  It  is  usual  to  speak  of  the  characteristic  pellicle  as 
if  it  were  peculiar  to  diptheria  ;  but  this  is  by  no  means 
the  case.  It  is  not  unfrequently  seen  in  cases  of  typhus 


The  False  Membkaxe. 


65 


and  relaxing  fever,  sometimes  in  yellow  fever,  and,  I 
believe,  in  all  fevers.  A  series  of  carefully  conducted 
experiments,  made  with  a  thorough  knowledge  of  cryp¬ 
togam!  c  botany,  on  lower  animals,  so  as  to  show  the 
real  pathological  origin  and  effects  of  these  parasitic 
fungi,  would  be  very  valuable.  It  would  be  absolutely 
necessary,  however,  that  the  animals  experimented  on 
be  first  brought  as  nearly  as  possible  under,  and  into, 
the  same  conditions  as  persons  are  in  who  are  attacked 
by  the  disease.  I  am  inclined  to  think  that  it  would 
probably  be  shown  that  these  parasites  may  act  either 
through  the  blood  or  locally  only.” 

THE  FALSE  MEMBRANE. 

In  all  forms  of  disease — distinguishing  action ,  which 
constitutes  the  essence  of  disease,  from  condition , 
which  may  be  its  cause,  accompaniment,  or  effect — 
there  is  an  effort  on  the  part  of  the  living  organism  to 
rid  itself  of  abnormal  conditions,  effete  matters,  foreign 
substances,  or  what  modern  physicians  have,  with  sin¬ 
gular  absurdity,  denominated  “  morbid  poisons ;”  in¬ 
deed,  this  process  of  depuration,  as  I  have  already 
explained,  constitutes  the  “  essential  nature  of  disease.” 
When  the  process  of  depuration  is  directed  mainly 
through  the  ordinary  channels — the  skin,  liver,  bowels, 
kidneys,  and  lungs — we  have  the  simple  fevers,  vary¬ 
ing  in  form  and  phenomena,  in  type  and  diathesis,  ac¬ 
cording  to  the  quantity  and  quality  of  the  impurities, 
etc.,  to  be  expelled,  and  the  greater  or  less  vigor  of  the 
various  organs  at  the  time  ;  these  circumstances  afford¬ 
ing  the  rationale  of  the  distinctions  of  simple  fevers 
into  inflammatory,  bilious,  typhoid,  continued,  remit¬ 
tent,  intermittent,  ephemeral,  etc.  When  the  noxious 


66 


Diptheria. 


materials  are  determined  almost  wholly  to  the  surface, 
and  are  of  a  nature  to  he  eliminated  only,  except  to  a 
small  extent,  through  the  cutaneous  emunctory,  we 
have  the  various  forms  of  eruptive  fevers — small-pox, 
measles,  scarlet  fever,  erysipelas,  miliary  fever,  etc. 
In  these  eruptive  fevers  there  is,  in  almost  all  cases, 
more  or  less  expulsion  of  morbid  matter  upon  the  sur¬ 
faces  of  the  mucous  membranes,  constituting  an  erup¬ 
tion,  exudation,  or  ulceration  of  the  part.  In  one  form 
of  scarlet  fever — scarlatina  maligna — the  determina¬ 
tion  of  morbid  matter  is  mainly  to  the  throat,  present¬ 
ing  what  has  frequently  been  called  “putrid  sore 
throat.”  In  some  conditions  of  the  system  the  noxious 
materials  are  thrown  upon  the  mucous  membrane  of 
the  trachea  or  windpipe,  and  so  charged  wTitli  the  fibri¬ 
nous  element  of  the  blood — coagulable  lymph — that, 
after  being  removed  from  its  normal  relations,  it  con¬ 
cretes  into  a  false  membranous  coating,  constituting 
true  croup  •  or,  if  the  fibrinous  element  is  incapable 
of  being  thus  partially  or  imperfectly  organized,  and 
is  expectorated  as  a  dense,  glairy  excretum,  it  consti¬ 
tutes  the  false  or  non-mrmhranous  croup .  When  mor¬ 
bid  matter  thus  affects  the  tonsils,  or  is  specially 
determined  to  the  mucous  surfaces  of  the  nose,  or  of 
the  fauces,  we  have  the  common  quinsy ,  or  the  catarrh, 
or  the  malignant  quinsy — the  “  black  tougue”  of  do¬ 
mestic  animals.  And  when  the  fibrinous  material  is 
exuded  over  a  greater  or  less  portion  of  the  mucous 
membrane  of  the  month,  whether  or  not  involving  the 
larynx,  trachea,  bronchia,  and  esophagus,  it  constitutes 
the  disease  which  is  generally  recognized  as  diptheria. 
This  exudation  also  occurs  in  some  cases  of  diarrhea 
and  dysmennorrhea,  and  in  catarrh  of  the  bladder  ;  or 
rather,  the  inflammatory  process  which  excretes  the 


The  False  Membeane. 


67 


membranous  matter  is  the  cause  of  those  particular 
forms  of  disease  which  have  been  termed  tubular  diar¬ 
rhea ,  painful  menstruation ,  and  catarrh  of  the  blad¬ 
der.  In  these  cases  the  membranous  formation  is 
usually  broken  up  by  the  contraction  of  the  parts,  and 
expelled  in  fragments.  In  some  cases,  however,  it  has 
been  cast  off  entire,  and  then  not  unfrequently  mis¬ 
taken  for  a  sloughing  and  expulsion  of  the  mucous 
membrane  itself.  Even  old  and  experienced  professors 
of  obstetrics,  and  authors  of  standard  works  on  dis¬ 
eases  of  women,  very  often  mistake  this  morbid  pro¬ 
duct  for  the  “  cast-off  mucous  membrane,”  when  the 
uterus  is  the  seat  of  the  exudation. 

Dr.  Winne  has  collated  from  various  writers  a  very 
good  description  of  the  false  membrane  of  ordinary 
diptheria.  “When  the  mouth  is  examined  upon  the 
first  day  of  the  pseudo-membranous  deposit,  the  parts 
destined  to  become  the  seat  of  the  disease  present  the 
appearance  of  pieces  of  flesh  bleached  by  contact  with 
boiling  water  ;  soon  after  there  appears  on  the  tonsils, 
the  uvula,  or  the  soft  palate,  small  vesicular  points  of  a 
lardaceous  appearance,  formed  by  the  dissolving  of  the 
epithelium,  which  may  readily  be  confounded  with 
the  minute  yellow  patches  soon  to  appear.  The  mem¬ 
brane  is  almost  invariably  developed  on  one  or  the 
other  of  the  tonsils,  but  not  always,  as  the  uvula  is 
sometimes  the  original  seat  of  the  patches.” 

Ordinarily,  at  the  moment  of  formation,  or  soon 
after,  the  false  membrane  appears  under  the  form  of 
a  white  or  a  yellowish- white  spot,  rarely  gray,  quite 
circumscribed,  a  little  projecting  at  its  center,  and  sur¬ 
rounded  by  a  circle  of  lively  red.  Sometimes  the 
false  membrane  is  semi-transparent  and  forms  a  slight 
pellicle,  which  envelops  the  tonsils,  through  which  the 


68 


Diptiieeia. 


surface  of  this  gland  is  partially  visible  ;  but  it  soon 
loses  this  transparency  and  becomes  of  a  yellowish- 
white  color,  extending  itself  to  the  subjacent  parts 
with  greater  or  less  rapidity,  according  to  a  variety  of 
circumstances,  and  especially  the  kind  of  treatment 
which  has  been  adopted.  After  the  false  membrane 
has  developed  itself  upon  the  tonsils,  it  usually  extends 
to  the  soft  palate,  the  uvula,  and  finally  to  the  phar¬ 
ynx,  with  greater  or  less  facility,  regularly  involving 
these  different  parts  in  the  order  here  indicated.  This 
is  not  invariably  the  case,  for  sometimes  it  is  developed 
simultaneously  in  several  distinct  points,  which  finally 
converge  the  one  into  the  other,  and  finish  by  forming 
a  continuous  surface.  While  it  is  thus  enlarging  its 
boundary,  the  false  membrane  acquires  an  additional 
thickness  by  the  crossing  of  successive  layers,  so  that 
it  is  not  composed  of  one  single  film,  but  of  many, 
which  present  a  varied  appearance,  dependent  upon 
the  place  occupied  by  them,  “sometimes  appearing  like 
a  deep  ulcer  with  a  yellow  base  ;  at  others,  enveloping 
the  uvula  as  a  finger  by  a  glove,  and  on  the  palate 
having  the  semblance  of  a  deep  hollow. 

“The  period  between  the  formation  of  this  mem¬ 
brane  and  its  dislodgment  is  very  variable — usually 
from  one  to  six  days.  In  the  early  part  of  the  disease, 
after  being  detached,  a  new  membrane  forms  in  its 
place,  and  this  may  be  habitually  reproduced  several 
times.  When  the  membrane  is  cast  off  spontaneously 
about  the  sixth  .or  seventh  day,  its  place  is  seldom  sup¬ 
plied  by  a  new  deposit ;  and  about  the  tenth  day  the 
patient  is  convalescent.  When  the  case  terminates 
fatally,  the  original  inflammation  extends  to  the  air- 
passages,  and  not  unfrequently  to  the  nasal  cavities, 
which  likewise  become  the  seat  of  a  pseudo-membrane, 


The  False  Membrane. 


69 


greatly  augmenting  the  sufferings  of  the  patient  and 
the  gravity  of  the  disease,  whose  termination  is  herald¬ 
ed  by  the  fetid,  sanious  discharge  from  the  nostrils, 
and  symptoms  of  angina,  which  speedily  supervene. 

“  When  the  termination  is  hastened  by  the  super¬ 
vention  of  gangrene,  the  pseudo-membrane  loses  its 
consistency,  is  easily  detached,  changes  to  a  grayish 
color  frequently  mixed  with  bloody  spots,  and  is  coated 
with  a  sanious  fluid  which  flows  from  the  mouth  and 
nostrils,  and  emits  a  very  fetid  odor.  The  flow  of 
blood  in  these  cases  is  sometimes  considerable,  and  not 
unfrequently  covers  the  lips  and  nasal  cavities,  in 
which  latter  the  flow  is  often  arrested  by  the  formation 
of  clots. 

“  Whatever  may  be  the  time  at  which  the  false 
membrane  becomes  detached,  it  generally  exhibits  the 
subjacent  tissues  diminished  in  size,  and  of  a  redness 
more  or  less  intense  in  color.  This  diminution  in  size 
is  especially  noticeable  in  the  tonsils  and  uvula.  The 
false  membrane  does  not  always  occupy  the  same  seat.” 

Dr.  Piclienot,  in  a  report  to  the  Paris  Academy  of 
Medicine,  describes  the  local  symptoms  of  a  very  fatal 
diptheria  which  prevailed  epidemically  in  the  Com¬ 
mune  of  Creusery,  in  1855  :  “  The  tonsils  press  upon 
the  folds  of  the  soft  palate,  and  their  surface  is  injected 
with  a  grayish  deposit.  But  it  is  upon  the  mucous 
membrane  of  the  posterior  portion  of  the  throat  that 
the  diptheritic  plagues  usually  present  themselves,  and 
their  grave  condition  here  almost  invariably  presages 
grave  and  rapid  disease,  and  not  unfrequently  a  fatal 
termination.  The  pain  in  the  head  and  neck  now  be¬ 
comes  augmented,  the  respiration  more  difficult,  the 
face  edematous,  and  the  maxillary  glands  tumefied  and 
sensitive  to  pressure. 


70 


Dipthekia. 


“  Its  march  is  very  rapid.  In  the  space  of  from 
three  to  five  honrs  the  papular  eminences  of  the  throat 
become  covered  with  a  flocculent,  transparent  vail,  of 
white  appearance.  Generally,  not  more  than  one  half 
of  the  guttural  cavity  is  at  first  invaded.  The  remain¬ 
der  of  the  mucous  surface  of  the  throat,  the  uvula, 
and  the  nasal  cavities  not  being  affected  by  the 
membrane,  which  soon  loses  its  transparency,  aug¬ 
ments  notably  in  thickness,  and  degenerates  into  the 
true  diptheritic  membrane,  of  a  gray  or  yellowish 
color. 

“  The  false  membrane  is  not  always  continuous,  and 
I  have  seen  several  times  the  tonsils,  and  the  pharynx, 
in  whole  or  in  part,  recovered  from  the  membranous 
deposit  while  it  was  progressing  upon  the  soft  palate. 
The  membranous  fold  is  easily  separated  by  traction, 
the  use  of  caustics,  and  often  by  Nature,  when  it  ap¬ 
pears  circumscribed  by  a  red  circle.  In  all  these  cases 
it  returns  again  very  promptly,  but  is  less  thick,  and 
is  often  reproduced  upon  a  surface,  which  exhales  a 
fetid  and  sanious  liquid.  In  some  very  rare  cases  the 
membrane  never  falls,  but  is  slowly  reabsorbed.  The 
voice  becomes  nasal ;  the  mouth,  which  rests  open,  and 
the  nostrils,  exude  continually  an  ichorish  fluid,  which 
becomes  more  fetid  as  the  disease  progresses,  and 
thickened  with  the  exfoliated  shreds  of  the  false  mem¬ 
brane.  The  head,  neck,  and  chest  often  present  a  uni¬ 
form  plane,  in  which  the  swelling  is  considerable.  Res¬ 
piration  and  deglutition  are  rendered  almost  impossi¬ 
ble,  by  the  increased  size  of  the  tonsils  and  the  in¬ 
vasion  of  the  false  membrane ;  the  prostration  is  ex¬ 
treme  ;  the  patient  is  not  able  to  raise  his  head ;  the 
pulse  becomes  imperceptible,  the  extremities  cold,  the 
intelligence  almost  always  intact,  the  lips  cyanosed, 


The  False  Membrane. 


71 


the  eyes  vitreous,  and  death  comes  to  terminate  the 
frightful  spectacle. 

“Such  are  generally  the  symptoms  when  the  case 
terminates  fatally.  During  the  first  four  months  of 
the  epidemic,  death  occurred  from  the  second  to  the 
fourth  day  of  the  disease,  and  life  was  rarely  prolonged 
beyond  the  sixth.  Upon  the  decline  of  the  epidemic, 
the  progress  of  the  disease  was  more  tardy,  and  fre¬ 
quently  extended  to  the  tenth  day.” 

M.  Bretonneau  thus  describes  the  specific  character 
of  the  diptheritic  exudation  : 

“  At  the  beginning  of  the  disease  there  is  perceived 
a  circumscribed  redness,  which  is  covered  with  semi¬ 
transparent  coagulated  mucus.  This  first  layer,  thin, 
supple,  and  porous,  may  be  still  elevated  by  portions 
of  the  unaltered  mucous  membrane  in  such  a  manner  as 
to  form  vesicles.  Often  in  a  few  hours  the  red  patches 
visibly  extend  step  by  step,  through  continuity  or  con¬ 
tact,  in  the  manner  of  a  liquid  which  is  poured  out  on 
a  plane  surface,  or  which  runs  by  striae  into  one  chan¬ 
nel.  The  concretion  becomes  opaque,  white,  and  thick  ; 
it  assumes  a  membranous  consistence.  At  this  period 
it  is  easily  detached,  and  adheres  to  the  mucous  mem¬ 
brane  only  by  very  delicate  prolongations  of  a  concrete 
matter,  which  penetrates  into  the  municiparous  folli¬ 
cles.  The  surface  which  it  covers  is  usually  of  a  slightly 
red  tint,  dotted  with  a  deeper  red ;  this  tint  is  more 
vivid  at  the  periphery  of  the  patches.  If  the  false 
membrane  be  detached,  and  leave  exposed  the  mucous 
surface,  the  redness  which  appeared  subdued  under 
the  concretion  reappears,  blood  transudes  through  the 
deep  red  points,  the  concretion  reappears,  and  becomes 
more  and  more  adherent  upon  the  points  first  invaded. 
It  often  acquires  a  thickness  of  several  lines,  and  passes 


Diptiieeia. 


72 

from  a  yellowish-white  to  a  grayish  and  to  a  black 
color.  At  the  same  time  the  blood  transudes  with 
more  facility,  and  constitutes  those  stillicidia  which 
have  been  generally  remarked  by  authors. 

“blow,  the  alteration  of  the  organic  surfaces  is  more 
apparent  than  at  the  beginning ;  often  portions  of  con¬ 
crete  matter  are  effused  into  the  substances  itself  of  the 
mucous  membrane;  there  is  observed  also  a  slight 
erosion,  and  sometimes  echymosis  in  points,  which,  by 
their  situation,  are  exposed  to  friction,  or  from  which 
the  avulsion  of  the  false  membranes  has  been  attempt¬ 
ed.  It  is  especially  about  this  time  that  the  concre¬ 
tions  which  have  become  putrid  give  out  infectious 
matter.  If  the  concretions  are  circumscribed,  the  ede¬ 
matous  swelling  of  the  cellular  tissue  immediately 
around  makes  the  former  appear  depressed,  and,  judg¬ 
ing  from  this  appearance  only,  we  might  be  tempted 
to  believe  that  we  had  under  observation  a  foul  ulcer 
with  considerable  loss  of  substance. 

“  If,  on  the  contrary,  they  are  extended  over  consid¬ 
erable  surface,  they  become  partially  detached,  and 
hang  in  shreds  more  or  less  putrefied,  and  simulate  the 
last  stage  of  spachelus ;  but  when  we  open  the  body  of 
those  who,  several  days  sick,  have  succumbed  to  tra¬ 
cheal  diptheritis,  we  shall  find  in  the  air-passages  ail 
the  shades  of  this  inflammation  from  its  first  degree,  as 
shown  in  the  portions  just  invaded,  up  to  that  which 
has,  by  its  deceptive  appearance,  led  us  for  a  moment 
to  dread  the  supervention  of  gangrene.” 

M.  Empis  regards  the  commencement  of  the  false 
membrane  as  a  process  of  coagulation,  which  takes 
place  by  a  precipitation  of  fibrin,  independently  of  any 
agency  of  the  living  tissue.  This  is  to  be  seen  most 
distinctly  in  the  air-passages,  particularly  in  the  larynx 


The  False  Membrane. 


73 

and  trachea,  in  which  the  tubular  cast  is  seldom  adher¬ 
ent,  and  is  commonly  much  smaller  than  the  cavity  it 
occupies ;  its  external  surface,  therefore,  being  sepa¬ 
rated  by  a  considerable  interval  from  the  mucous 
membrane.  That  coagulation  is  not  occasioned  by  the 
influence  or  action  of  the  mucous  membrane  is  re¬ 
garded  by  M.  Empis  as  proved  by  his  experience  in 
cases  where  tracheotomy  has  been  performed  : 

“  At  the  end  of  a  few  hours  after  the  operation, 
whatever  care  might  be  taken  to  clear  the  canula,  the 
instrument  was  seen  to  be  lined  with  a  layer  of  whitish 
concretions,  the  thickness  of  which  continually  in¬ 
creased.  These  concretions  were  evidently  only  the 
result  of  the  coagulation  of  the  liquid  by  which  the 
sides  of  the  canula  were  constantly  covered. 

“  The  pellicle  thus  formed,”  says  Dr.  Slade,  of  Bos¬ 
ton  (uDiptheria;  its  Mature  and  Treatment”),  u  which 
may  be  considered  as  the  first  degree  of  false  mem¬ 
brane,  is  thicker  at  the  center  than  at  the  circumfer¬ 
ence,  and  generally  may  be  lifted  up,  although  in  very 
small  pieces,  owing  to  its  friability.  Beneath  this  su¬ 
perficial  pellicle,  according  to  M.  Empis,  there  is  still 
an  exudation  of  sero-mucous  matter,  which  gradu¬ 
ally  coalesces  with  the  pellicle  already  formed,  thus 
producing  a  false  membrane  several  lines  in  thick¬ 
ness,  and  adhering  to  the  subjacent  surface  very 
closely. 

“  In  many  cases  the  membrane  thus  formed  appears 
to  remain  for  some  time  stationary,  and  then,  sooner  or 
later,  it  takes  on  an  increase  in  thickness  as  well  as  in 
extent  of  surface.  The  secretion  of  sanious  fluid  which 
imbues  and  softens  the  concretions  is  also  increased, 
becomes  very  dark-colored,  and  exhales  a  fetid  odor, 
similar  to  that  of  gangrene.  This  especially  applies  to 

4 


n 


Diptheeia. 


the  deeper  portions  of  the  fauces,  to  the  vulva,  and  to 
the  anterior  parts  of  the  vagina.” 

M.  Empis  remarks,  with  regard  to  the  cicatrization 
of  the  membrane : 

“  We  never  see  the  membrane  disappear  all  at  once, 
leaving  in  its  place  a  cicatrized  surface,  as  is  the  case 
with  an  ordinary  eschar,  but  it  is  by  a  gradual  process 
that  the  pellicle  diminishes  in  thickness,  in  proportion 
as  the  edges  of  the  abraded  surface  cicatrize.  If,  how¬ 
ever,  we  modify  the  secreting  surface  by  an  energetic 
local  treatment,  we  can  cause  the  complete  disappear¬ 
ance  of  the  membrane,  leaving  nothing  beneath  but  a 
granulating  surface  of  a  healthy  character.” 

Any  portion  of  the  external  surface  of  the  body 
where  the  epidermis  is  absent,  and  also  the  surfaces  of 
ulcers  and  wounds,  may  become  affected  with  dipthe- 
ritic  exudation  as  well  as  the  mucous  membrane.  In 
some  cutaneous  affections  which  have  prevailed  epi¬ 
demically,  and  especially  in  France,  the  “  cutaneous 
diptheria”  has  been  a  prominent  feature.  Blistered 
surfaces,  leech  bites,  excoriations  of  any  part,  when 
the  disease  prevails  epidemically,  are  liable  to  become 
the  seat  of  diptheritic  inflammation ;  and  the  external 
manifestation  of  the  diptheritic  poison  is  said  to  be  at¬ 
tended  with  results  quite  as  disastrous  as  are  its  de¬ 
positions  on  the  mucous  membrane. 

“  When  a  wound  is  attacked  by  diptheritic  inflam¬ 
mation,”  says  Dr.  Slade,  “it  becomes  painful,  fetid, 
and  discolored  ;  serosity  pours  from  it  in  abundance, 
and  a  gray,  soft  coating  soon  covers  it  with  a  layer  of 
increasing  thickness ;  the  edges  swell  and  become 
violet.  The  wound  remains  often  obstinately  station¬ 
ary  for  months ;  sometimes  it  spreads,  then  around  it 
an  erysipelatous  blush  is  seen  ;  pustules  form,  become 


The  False  Membrane. 


75 


confluent,  burst,  and  leave  apparent  a  diptheritic 
patch,  which  spreads  even  from  the  head  to  the  loins. 

“  A  curious  fact  which  has  been  observed  as  regards 
the  seat  of  diptheritic  exudation  is,  that  although  it  is 
found  equally  in  the  mouth,  on  the  soft  palate,  the  ton¬ 
sils,  the  pharynx,  the  nasal  fossse,  the  larynx,  trachea, 
and  even  in  the  bronchial  tubes,  on  the  conjunctiva, 
the  vulva  and  anus,  and  upon  the  skin,  it  is  not  found 
upon  those  portions  which  are  removed  from  the  con¬ 
tact  of  the  air ;  these  seem  refractory  to  the  extension 
of  the  disease.  M.  Empis  remarks  that  he  never  saw 
true  diptheria  extend  into  the  esophagus ;  while,  on 
the  contrary,  the  exudation  of  certain  apthous  affec¬ 
tions  shows  a  great  tendency  to  spread  into  the  esoph¬ 
agus,  but  never  into  the  respiratory  organs.  The 
atmosphere  would  thus  certainly  seem  to  exert  an  in¬ 
fluence  in  promoting  diptheritic  inflammation.” 

I  must  reason  a  little  differently  from  the  authors 
just  quoted.  I  do  not  think  the  facts  prove  that  “  at¬ 
mospheric  air  promotes  diptheritic  inflammation,”  but 
that  after  the  diptheritic  excretion  has  taken  place,  the 
influence  of  the  atmosphere  will  favor  the  concretion 
of  the  fibrinous  material  exuded  into  the  dense  coating 
which  constitutes  the  false  membrane.  And  this  ex¬ 
planation  is  corroborated,  if  not  absolutely  demon¬ 
strated,  by  the  fact  that  the  membrane  is  not  unfre- 
quently  formed  in  the  bowels,  bladder,  and  uterus,  as 
we  have  already  seen. 

M.  Empis,  who  has  examined  the  false  membrane 
microscopically,  declares  that  it  is  impossible  to  draw 
any  distinction,  founded  on  microscopic  investigation, 
between  the  exudation  of  diptheria  and  that  of  a  blis¬ 
tered  surface,  or  that  which  occurs  in  the  throat  affec¬ 
tion  of  malignant  scarlet  fever. 


76 


Dipthekia. 


HISTORY  OF  DIPTHERIA. 

The  first  distinct  description  of  a  form  of  malignant 
sore  throat  is  found  in  the  writings  of  Aretseus,  who 
lived  about  the  time  of  Galen,  under  the  name  of 
Egyptian  or  Syrian  ulcer.  Macrobius  mentions  a  simi¬ 
lar  disease  which  prevailed  in  Rome,  A.D.  380 ;  and 
“there-  is  reason  to  suppose,”  says  Dr.  Greenhow, 
“  that  we  can  trace  back  the  history  of  this  affection  to 
a  period  almost  cotemporary  with  Homer.”  In  1337  a 
fatal  epidemic  of  sore  throat  occurred  in  Holland.  In 
1576  it  prevailed  epidemically  in  Paris.  In  1618-19 
it  destroyed  five  thousand  victims  in  Naples ;  and 
about  this  period  it  prevailed  as  an  epidemic  in  Spain 
for  forty  years.  In  1636  it  prevailed  at  Kingston,  Ja¬ 
maica;  in  1736  it  appeared  in  Boston,  and  in  1743  it 
reappeared  in  Paris,  where  it  continued  until  1748. 
In  1749  it  appeared  at  Cremona  and  in  England.  In 
1770  it  was  first  noticed  in  New  York  and  described 
by  Dr.  Samuel  Bard. 

Dr.  "Winne,  in  the  paper  heretofore  mentioned,  pre¬ 
sents  a  rapid  sketch  of  the  most  important  historical 
data,  from  which  I  extract : 

“  It  was  not,  however,  until  its  appearance  at  Tours 
in  1818,  that  it  assumed  the  name  of  Diptherite,  by 
which  it  is  generally  recognized  in  England  and  the 
United  States,  at  the  hands  of  M.  Bretonneau,  whose 
investigations  have  largely  contributed  to  the  present 
fund  of  knowledge  on  this  subject,  and  to  whom  the 
first  connected  and  practical  researches  are  due.  Dip¬ 
therite  made  its  first  appearance  at  Tours  in  1818,  in 
the  barracks  of  the  soldiers,  in  the  rear  of  the  legion  of 
La  Yendee,  and  from  thence  spread  to  the  surrounding 


History. 


77 


quarters.  The  attack  among  the  soldiers  was  usually 
a  gingival  diptheria,  but  as  it  spread  into  the  city  the 
larynx  became  the  seat  of  the  disease,  and  the  gums 
were  not  largely  affected.  From  Tours  the  disease 
slowly  spread  to  La  Ferriere,  which  it  reached  in  1824, 
where,  out  of  two  hundred  and  fifty  inhabitants, 
twenty-one  were  attacked  and  eight  died.  In  1825 
the  communes  north  of  Orleans  were  attacked ;  and  in 
1828  those  south  of  Orleans  suffered  from  this  disease. 

“  In  1821  M.  Bretonneau  presented  a  memoir  to  the 
Academy  of  Medicine,  at  Paris,  on  diptheria,  as  it  had 
prevailed  at  Tours,  which  was  followed  by  several 
others  in  subsequent  years.  The  whole  of  his  laborious 
and  exact  researches  were  finally  given  to  the  world  in 
his  treatise  entitled,  ‘  Des  inflammations  speciales  du 
tissu  muqueux  et  en  particulier  de  la  diptherite ,  ou  in¬ 
flammation  pelliculaireP  From  the  period  of  its  out¬ 
break  at  Tours,  diptheria  appears  to  have  seldom  or 
never  been  absent  from  one  or  the  other  of  the  depart¬ 
ments  of  France,  pursuing  a  very  erratic  course,  both 
as  to  its  mode  of  visitation  and  the  intensity  of  its 
attacks,  so  that  the  annual  reports  of  the  French  Acad¬ 
emy  of  Medicine  on  prevailing  epidemics  seldom  fail 
to  note  its  existence  in  some  portions  of  the  empire. 
The  visitations,  however,  which  have  produced  the 
greatest  alarm,  not  only  on  account  of  their  severity, 
but  also  because  of  the  respectability  of  the  victims, 
were  those  of  Paris  and  Boulogne  in  1855.  The  dis¬ 
ease  at  Paris  attacked  both  rich  and  poor,  and  while  it 
carried  off  a  large  number  of  children,  proved  fatal  to 
many  adults,  more  especially  those  who  were  often  in 
attendance  upon  the  sick.  Among  these  was  the  emi¬ 
nent  medical  writer,  Yalleix.  That,  however,  at  Bou¬ 
logne  was  not  only  the  gravest,  but  of  the  longest  du- 


78 


Diptheeia. 


ration,  continuing  from  January,  1855,  to  March,  1857. 
During  tliis  period  it  caused  366  deaths,  of  which  341 
were  of  children  under  ten  years  of  age.  In  this  epi¬ 
demic,  as  in  that  of  Paris,  no  condition  was  spared ; 
and,  indeed,  the  attack  seemed  to  fall  with  the  greatest 
severity  upon  the  children  of  the  wealthy  English  resi¬ 
dents,  who,  from  their  more  favorable  hygienic  position, 
might  be  supposed  to  enjoy  a  comparative  immunity 
from  epidemic  disease. 

“  Nor  does  its  fatality  appear  to  have  been  diminished 
in  subsequent  years,  for  in  the  report  for  1858,  read  by 
Trousseau,  22d  November,  1859,  it  is  stated  that  dip- 
tlieria  prevailed  in  31  departments,  and  attacked  1,568 
adults  and  7,474  children;  of  these,  165  adults  and 
3,384  children  died. 

“In .England,  the  disease  first  presented  itself  in  the 
south-eastern  counties  nearly  opposite  Boulogne,  in  the 
early  part  of  1857  ;  and  traveling  from  station  to  sta¬ 
tion,  visited  especially  the  ill-drained  and  marshy  dis¬ 
tricts,  and  the  neglected  and  unhealthy  localities  in 
towns.  Some  of  the  first  cases  occurred  in  the  practice 
of  Mr.  Pigden,  of  Canterbury,  at  the  beginning  of  the 
year.  He  describes  £  seven  cases  of  diptheritic  inflam¬ 
mation  of  the  fauces  and  tonsils,  attended  with  consid¬ 
erable  fever,  depression  and  swelling  of  the  tonsils,  the 
fauces  and  part  of  the  mouth  being  covered  with  a 
pasty  lymph.’  From  this  point  it  gradually  diffused 
itself  through  the  eastern  counties,  fastening  especially 
upon  the  marshy  districts,  in  which  the  attacks  were 
numerous,  although  the  mortality  was  not  in  propor¬ 
tion  to  the  number  of  cases.  During  the  winter  months 
of  1857  it  had  largely  diffused  itself  through  the  county 
of  Essex,  causing  eight  out  of  twenty  deaths,  and  en¬ 
hancing  the  rate  of  mortality  in  Suffolk  and  Norfolk 


History. 


79 


in  tlie  proportion  of  three  to  one.  The  disease  appeared 
to  lull  during  the  summer,  hut  in  the  autumn  of  1858 
it  largely  extended  its  boundaries,  and  became  quite 
prevalent  in  the  north  midland  counties.  The  county 
of  Lincolnshire  appeared  to  suffer  more  severely  than 
any  other  in  England,  no  less  than  eighty-two  deaths 
being  attributed  to  this  cause.  In  the  northwestern 
counties  it  prevailed  in  conjunction  with  whooping- 
cough,  and  in  Nantwich  caused  thirteen  out  of  fifty- 
nine  deaths.  It  was  observed  at  "Wigan,  Liverpool, 
and  Hulme,  as  well  as  at  Bosendale,  in  which  latter 
place  sixteen  out  of  sixty-eight  deaths  were  attributed 
to  its  influence. 

“Diptheria  prevailed  at  Lima,  South  America,  in 
1855,  and  again  in  1858,  and  is  very  well  described  in 
the  concise  account  given  by  Dr.  Odriazala,  a  Spanish 
physician,  resident  at  Lima.  In  1855  it  appeared  in 
California,  and  prevailed  extensively  not  only  in  San 
Francisco  and  Sacramento,  but  likewise  in  the  various 
mining  districts  throughout  the  State.  In  Placer 
County  it  was  quite  prevalent,  but  among  the  districts 
which  suffered  most  was  that  of  Sonora.  The  number 
of  cases  was  very  numerous,  and  the  deaths  in  the  ag¬ 
gregate  large,  but  there  is  no  means  of  determining 
the  relative  proportion  which  they  bore  to  the  number 
affected.  Dr.  Blake  states  that  at  Cache  Creek,  about 
twenty  miles  from  Sacramento,  the  children  during 
1855  and  1857  were  almost  decimated  by  this  disease. 
At  Cache  Creek  it  was  principally  during  the  spring 
and  summer  months  that  the  disease  showed  itself ; 
and  Dr.  Bynum,  who  had  attended  nearly  two  hundred 
cases,  states  that  the  affection  always  appeared  more 
virulent  after  the  prevalence  of  a  north  wind,  which  is 
a  dry  and  cold  one. 


80 


Diptheria. 


“  In  regard  to  the  conditions  under  which  it  appear¬ 
ed,  Dr.  Blake  says  it  is  usually  stated  that  4  it  generally 
prevails  in  low  situations,  and  to  a  certain  extent  this 
is  true ;  although  the  most  fatal  epidemic  of  the  dis¬ 
ease  that  came  under  my  observation  was  at  a  mining 
village  called  Dutch  Flat,  situated  in  a  hollow  sur¬ 
rounded  by  hills,  about  4,000  feet  above  the  sea.  There 
were  thirteen  children  in  the  village,  all  of  whom  were 
attacked,  and  four  died.  At  Grass  Yalley,  which  is 
similarly  situated  at  an  altitude  of  2,300  feet,  the  num¬ 
ber  of  cases  wTas  great,  and  the  mortality  considerable. 
It  was  chiefly,  however,  in  the  Sacramento  valleys  and 
in  the  valleys  of  the  coast  range  that  the  disease  was 
most  prevalent.5  The  disease  again  renewed  its  at¬ 
tack  in  1858,  and  is  accurately  described  by  Dr.  Four- 
geaud,  in  a  ‘  Concise  and  Critical  Essay  on  the  late 
Pseudo-Membranous  Sore  Throat  of  California.5 

“  The  most  alarming  as  well  as  the  most  fatal  out¬ 
break  of  the  disease  in  the  United  States  occurred  in  Al¬ 
bany,  in  1858.  The  first  case  occurred  in  the  south  part 
of  the  city,  on  the  2d  of  April  of  that  year  ;  the  second 
on  the  20th  of  April,  in  the  same  section  of  the  town. 
From  this  time  it  continued  to  increase  in  numbers  and 
severity.  During  the  twelve  months  in  which  it  reign¬ 
ed  as  an  epidemic  it  attacked  about  two  thousand  per¬ 
sons,  and  caused  one  hundred  and  ninety-seven  deaths, 
of  which  but  three  were  adults. 

“The  first  death  from  diptheria  reported  from  the 
office  of  the  City  Inspector,  in  Mew  York,  occurred  on 
the  20th  of  February,  1859,  in  the  practice  of  Dr. 
Maxwell ;  the  residence  of  the  child,  who  was  three 
and  a  half  years  old,  wTas  in  38th  Street,  near  5th 
Avenue.  The  second  death  occurred  at  Manhattan- 
ville,  on  the  25th  of  February ;  on  the  same  day,  a 


History. 


81 


third  fatal  case  was  reported  from  Stanton  Street.  On 
the  5th  of  March,  the  fourth  case  was  reported  from 
Yesey  Street ;  on  the  10th  of  March,  the  fifth  from  the 
lower  end  of  28th  Street ;  on  the  23d  of  March,  the 
sixth  from  Grand  Street,  near  the  East  Fiver ;  and  on 
the  28th  of  March,  the  seventh  from  Yarick  Street. 
During  the  month  of  April  three  deaths  were  re¬ 
ported;  in  May,  three ;  in  June,  two  ;  in  July,  two; 
in  August,  four ;  in  September,  five ;  in  October,  nine  ; 
in  November,  seven  ;  and  in  December,  ten.  The 
whole  number  of  deaths  for  1859  was  53,  of  which  30 
wrnre  males  and  23  females.  During  the  year  1860, 
the  number  of  fatal  cases  considerably  increased,  and 
the  prevalence  of  the  disease  as  reported  at  the  various 
Dispensaries  was  largely  augmented.  From  the  1st  to 
28th  January,  1860,  14  deaths  were  reported  by  the 
City  Inspector.  For  the  week  ending  February  4th, 
10  deaths  ;  for  that  ending  the  11th,  12  deaths ;  week 
ending  18th,  10  deaths;  for  week  ending  25th,  14 
deaths ;  for  week  ending  3d  March,  19  deaths ;  for 
week  ending  10th,  9  deaths  ;  for  week  ending  17th, 
13  deaths.  The  whole  number  of  deaths  from  diptlie- 
ria  in  1860  was  422. 

“  Previous  to  the  report  of  the  cases  above  alluded 
to,  some  deaths  from  diptheria  were  returned  to  the 
City  Inspector,  but  were  reported  under  the  head  of 
croup.  The  number  included  in  this  category  it  is  not 
possible  to  determine,  but  it  may  be  fairly  inferred 
that  they  were  not  numerous.  During  the  latter  part 
of  1858  and  the  early  part  of  1859,  a  remarkable  ten¬ 
dency  to  afiections  of  the  mucous  membranes,  es¬ 
pecially  of  the  throat,  was  observed,  and  this  became 
so  general  as  to  constitute  an  important  element  in  the 
medical  man’s  daily  practice.  Nor  was  this  confined 

4* 


82 


Diptheria. 


to  any  particular  part  of  the  city,  or  class  of  persons, 
"but  seemed  to  pervade  alike  the  habitations  of  the 
opulent,  and  the  confined,  ill- ventilated  apartments  of 
the  poor.  As  yet,  however,  no  diptheria  had  been  ob¬ 
served,  and  it  was  not  until  about  the  month  of  March 
that  medical  practitioners  here  and  there,  especially 
among  the  poor,  observed  a  thin  pellicular  covering 
over  the  tonsils,  interspersed  here  and  there  with  white 
star-like  specks,  which  gradually  expanded  in  size,  and 
in  severe  cases  came  to  cover  the  whole  of  the  tonsils, 
and  extend  over  the  other  soft  parts  of  the  throat  into 
the  larynx  on  the  one  side  and  the  nares  on  the  other. 
This  film-like  substance  could  be  easily  removed  with 
the  sponge  in  its  earlier  stages,  but  became  dense  and 
closely  adherent  as  the  disease  progressed. 

a  Reports  of  a  similar  disease  have  been  received 
from  every  part  of  the  United  States ;  and  in  many 
of  the  larger  places,  as  Boston,  Providence,  Philadel¬ 
phia,  Baltimore,  Richmond,  Rew  Orleans,  Cincinnati, 
Louisville,  and  St.  Louis,  as  well  as  in  the  rural  dis¬ 
tricts,  well-marked  cases  of  diptheria  have  been  ob¬ 
served,  and  in  each  the  bills  of  mortality  have  been 
increased  to  a  greater  or  less  extent  through  its  agency. 
Although  the  means  of  tracing  the  progress  of  this 
disease  through  the  United  States  do  not  exist,  yet  a 
sufficient  number  of  facts  is  known  to  establish  that 
it  has  not  as  in  England,  and  to  some  extent  in  Prance, 
pursued  a  progressive  line  of  march,  but  has  presented 
itself  here  and  there  in  the  most  erratic  manner,  and 
without  the  general  and  wide-spread  disposition  to  af¬ 
fections  of  the  mucous  membranes  which  everywhere 
prevailed,  and  for  the  most  part  still  continues.” 

In  his  account  of  the  “  sweating  sickness”  in  Eng¬ 
land,  in  1517,  Hecker  says  (‘‘Epidemics  of  the  Middle 


Histoky. 


83 


Ages”):  “In  January  of  that  year  there  appeared  in 
Holland  another  disease  which,  from  its  dangerous  and 
inexplicable  symptoms,  spread  fear  and  horror  around. 
It  was  a  malignant  and  infectious  inflammation  of  the 
throat,  so  rapid  in  its  course,  that,  unless  assistance 
was  procured  within  eight  hours,  the  patient  was  past 
all  hope  of  recovery  before  the  close  of  the  day.  Sud¬ 
den  pains  in  the  throat  and  violent  oppression  of  the 
chest,  especially  in  the  region  of  the  heart,  threatened 
suffocation,  and  at  length  actually  produced  it.  Dur¬ 
ing  the  paroxysms  the  muscles  of  the  throat  and  chest 
were  seized  with  violent  spasms,  and  there  were  but 
short  intervals  of  alleviation  before  a  repetition  of  such 
seizures  terminated  in  death.  Unattended  by  any  pre¬ 
monitory  symptoms,  the  disease  began  with  a  severe 
catarrhal  affection  of  the  chest,  which  speedily  ad¬ 
vanced  to  inflammation  of  the  air-passages.  In  Basle, 
within  eight  months,  it  destroyed  2,000  people.” 
r  In  the  year  1136,  Dr.  Douglass,  of  Boston,  published 
an  account  of  the  first  apj>earance  of  a  “  sore  throat 
distemper”  in  this  country.  The  epidemic  which  he 
describes  was  very  malignant,  and  was  attended  with 
“  erysipelatous  appearances  and  highly  putrid  symp¬ 
toms.” 

Under  date  of  October  1,  1753,  Mr.  Cadwallader 
Colden  addressed  a  letter  to  Dr.  Eothergill  concerning 
the  “  throat  distemper,”  which  was  published  in  the 
first  volume  of  “  Medical  Observations  and  Inquiries,” 
London.  Mr.  Colden  says  : 

“  The  first  appearance  of  the  throat  distemper  was 
at  Kingston,  an  inland  town  in  Hew  England,  about 
1735.  It  spread  from  there,  and  spread  gradually 
westward,  so  that  it  did  not  reach  Hudsoffs  river  till 
nearly  two  years  afterward.  It  continued  on  the  east 


84 


DirTHEEIA. 


side  of  Hudson’s  river  before  it  passed  to  the  west¬ 
ward,  and  appeared  first  in  those  places  to  which  the 
people  of  Hew  England  resorted  for  trade,  and  in  the 
places  through  which  they  traveled.  It  continued  to 
move  westwardly,  till  I  believe  it  has  at  last  spread 
over  all  the  British  colonies  on  the  continent.  Chil¬ 
dren  and  young  people  were  only  subject  to  it,  with  a 
few  exceptions  of  some  above  twenty  or  thirty,  and  a 
very  few  old  people  who  died  of  it.  The  poorer  sort 
of  people  were  more  liable  to  have  the  disease  than 
those  who  lived  well  with  all  the  conveniences  of  life, 
and  it  has  been  more  fatal  in  the  country  than  in  great 
towns. 

“  In  some  families  it  passed  like  a  plague  through 
all  their  children  ;  in  others,  only  one  or  two  were 
seized  with  it.  Ever  since  it  came  into  the  part  of  the 
country  where  I  live  (now  about  fourteen  years),  it 
frequently  breaks  out  in  different  families  and  places 
without  any  previous  observable  cause,  but  does  not 
spread  as  it  did  at  first.  It  seems  as  if  some  seeds,  or 
leaven,  or  secret  cause  remains  wherever  it  goes. 
When  the  distemper  becomes  obvious,  it  has  the  com¬ 
mon  symptoms  attending  a  fever,  except  that  a  nausea 
or  vomiting  is  seldom  observed  to  accompany  it.  The 
disease  is  not  often  attended  with  that  loss  of  strength 
that  is  usual  in  other  fevers ;  so  that  many  have  not 
been  confined  to  their  beds,  but  have  walked  about 
the  room  till  within  an  hour  or  two  of  their  death  ; 
and  it  has  often  appeared  no  way  dangerous  to  the 
attendants,  till  the  sick  were  on  their  last  agony.  Some 
died  on  the  fourth  or  fifth  day,  others  on  the  fourteenth 
or  fifteenth  day,  or  even  later.  When  this  disease 
first  appeared,  it  was  treated  with  the  usual  evacuations 
in  a  common  engina,  and  few  escaped.  In  many  fain- 


History. 


85 


ilies,  wlio  had  a  great  many  children,  all  died ;  no 
plague  was  more  destructive.5’ 

One  source  of  the  fatality  of  the  epidemic  described 
by  Mr.  Golden  is  indicated  in  that  significant  line, 
“  it  was  treated  with  evcicuants ,  and  few  escaped.55 
The  whole  history  of  all  malignant  epidemics  shows 
that  the  depleting  practice  of  the  physicians  has  caused 
more  deaths  than  would  have  occurred  had  the  disease 
been  left  to  itself,  and  the  powers  of  life  to  their  own 
unaided  resources. 

A  throat-disease,  in  all  essential  particulars,  pre¬ 
vailed  in  Sullivan  County,  N.  Y.,  in  November  and 
December,  1861  (principally  in  the  town  of  Lock  Shel¬ 
drake  and  its  immediate  vicinity),  and  although  there 
was  no  dearth  of  doctors  (from  three  to  six  consulting 
together  in  some  of  the  cases),  every  case  proved  fatal. 
Several  families  lost  all  of  their  children.  In  the  family 
of  a  Mr.  Kyle,  of  eleven  children,  nine  died.  Almost 
all  the  deaths  in  this  neighborhood  occurred  in  about 
forty-eight  hours  after  the  first  alarming  symptoms.  A 
large  proportion  of  these  patients  were  adults. 

In  the  epidemic  sore  throat  which  prevailed  in  New 
York  in  1771,  as  described  by  Dr.  Bard,  the  disease 
was  generally  confined  to  children  under  ten  years  of 
age.  The  symptoms  were  usually  so  mild  for  five  or 
six  days  as  to  create  little  alarm ;  after  which  occurred 
very  great  and  sudden  prostration  of  strength,  a  pecu¬ 
liar  hollow,  dry  cough,  and  a  remarkable  change  in  the 
tone  of  the  voice,  indicative  of  ulceration  in  the  laryn¬ 
geal  passage,  or  a  concretion  of  the  exuded  lymph. 

In  the  cases  described  by  Dr.  Bard,  the  swelling  of 
the  parotid,  sublingual,  and  submaxillary  glands,  men¬ 
tioned  by  other  authors  as  invariably  present,  was 
noticed  in  but  few  instances. 


88 


Diptheria. 


In  tlie  spring  of  1860,  the  disease  appeared  endemi- 
cally  near  New  Haven,  Conn.,  and  is  thus  described 
by  Dr.  L.  N.  Beardsley,  of  Milford — who  attended  the 
first  fifteen  cases — in  a  communication  to  the  Boston 
Medical  and  Surgical  Journal : 

“  This  disease  [diptheria]  appeared  in  an  endemic 
form,  and  with  great  mortality,  in  this  vicinity  during 
the  months  of  March  and  April  last.  It  first  made  its 
appearance  in  Orange,  an  adjoining  town  (which  is  in 
an  elevated  situation,  and  is  a  remarkably  healthy 
place,  with  a  sparse  population),  and  for  a  while  was 
confined  entirely  to  the  scholars  attending  a  select 
school  In  the  village.  Fourteen  out  of  fifteen  of  the 
cases,  of  those  who  were  first  attacked,  proved  fatal,  in 
periods  varying  from  six  to  twenty-four  days. 

“  Most  persons  residing  in  the  district  where  the 
disease  first  appeared,  sooner  or  later  had  some  mani¬ 
festations  of  the  disease.  The  period  of  incubation 
varied  from  five  to  twenty  days.  The  lymphatic 
glands  wrere  in  many  cases  greatly  enlarged.  The  first 
symptom — and  it  is  one  which  we  have  never  seen 
referred  to  by  any  writer  on  the  subject — was  pain  in 
the  ear.  It  was  not  only  pathognomonic  but  promi¬ 
nent,  and  almost  invariably  present  in  every  case  that 
came  under  our  observation,  in  a  day  or  two  before 
the  patient  made  the  least  complaint  in  any  other 
respect,  and  before  the  smallest  point  or  concretion  of 
lymphatic  exudation  could  be  discovered  on  the  tonsils 
or  elsewhere.” 

The  language  of  Dr.  Beardsley  is  a  little  muddled. 
To  be  u  pathognomonic,”  a  symptom  should  be  inva¬ 
riably  present,  and  not  “  almost  invariably,”  as  our 
author  expresses  it. 

During  the  years  1860  and  1861  diptheria  has  pre- 


Infectioitsness. 


87 


vailed  sporadically  or  endemically  in  nearly  all  sec¬ 
tions  of  the  United  States,  and  at  this  time,  so  far  as  I 
can  learn  from  extensive  correspondence  with  all  parts 
of  the  country,  it  seems  to  he  on  the  increase. 

INFECTIOUSNESS. 

Is  diptheria  contagious  ?  This  question  has  been 
much  discussed  by  medical  writers,  and,  as  has  been 
the  case  with  scarlet  fever,  yellow  fever,  plague,  and 
some  other  diseases,  the  testimony  adduced  pro  and  con 
seems  to  be  pretty  equally  balanced.  I  suspect  that 
the  disputants  on  both  sides  of  the  question  in  issue  are 
partly  right  and  partly  wrong.  I  am  of  opinion  that 
under  certain  circumstances  all  febrile  diseases  may 
be  contagious.  In  all  fevers  there  are  morbid  excre¬ 
tions  which,  if  due  attention  is  not  paid  to  ventilation 
and  cleanliness,  may  become  so  accumulated  and  con¬ 
centrated,  as  it  were,  as  to  infect  other  persons,  and 
thus  become  the  cause  of  a  similar  disease  in  them. 
Much  depends,  of  course,  on  the  greater  or  less  sus¬ 
ceptibility  of  the  individual  to  be  affected,  and  this 
susceptibility,  or  non-susceptibility,  is  nothing  more 
nor  less  than  the  grossness  or  purity  of  the  party 
exposed. 

Several  authors,  among  whom  is  M.  Bretonneau, 
have  maintained  that  the  exuded  matter  of  diptheria 
possesses  a  special  virulence,  and  that  the  disease  may 
be  propagated  by  the  application  of  the  secretion 
[excretion  ?]  from  an  affected  surface  to  sound  parts, 
like  small-pox  ;  and  he  contended  that,  like  syphilis, 
the  disease  can  only  be  communicated  by  contact,  thus 
rendering  it  technically  infectious ,  as  is  syphilis,  in¬ 
stead  of  both  infectious  and  contagious ,  as  is  small-pox. 


88 


Diptheeia. 


M.  Bretonneau  says :  “  Innumerable  facts  have 
proved  that  those  who  attend  patients  can  not  contract 
diptheria  unless  the  diptheritic  secretion  in  the  liquid 
or  pulverulent  state  is  placed  in  contact  with  the 
mucous  membrane,  or  with  the  skin  on  a  point  denuded 
of  epidermis,  and  this  application  must  be  immediate. 

“  The  c  Egyptian  disease’  is  not  communicated  by 
volatile  invisible  emanations,  susceptible  of  being  dis¬ 
solved  in  the  air,  and  of  acting  at  a  great  distance  from 
their  point  of  origin.  It  no  more  possesses  this  quality 
than  the  syphilitic  disease.  If  the  liquid  which  issues 
from  an  Egyptian  chancre,  as  visibly  as  that  which 
proceeds  from  a  venereal  chancre,  has  seemed  under 
certain  circumstances  to  act  like  some  volatile  forms 
of  virus,  the  mistake  lias  arisen  from  its  not  having 
been  studied  with  sufficient  attention.  The  appearance 
has  been  taken  for  the  reality.” 

In  support  of  the  doctrine  of  the  infectious  nature 
of  diptheria,  M.  Bretonneau  has  adduced  the  following 
among  other  cases  :  In  the  hospital  at  Tours,  a  child 
affected  with  diptheria,  in  a  fit  of  coughing,  ejected  a 
portion  of  the  diptheritic  matter  which  lodged  upon 
the  aperture  of  the  nostril  of  M.  Herpin,  the  surgeon, 
who  was  at  the  time  sponging  the  larynx  of  the  patient. 
This  M.  Herpin  neglected  immediately  to  remove,  and 
the  result  was  a  severe  diptheritic  inflammation  which 
spread  over  the  whole  nostril  and  pharynx,  attended 
with  extremely  severe  constitutional  symptoms,  with 
great  prostration,,  and  followed  by  a  slow  and  lingering 
convalescence  of  six  months’  duration.  This  child,  it 
is  also  stated,  had  transmitted  the  affection  to  its 
nurse. 

Dr.  Gendron,  of  Chateau  de  Loire,  having  received 
on  his  lips  portions  of  diptheritic  exudation,  expelled 


Infectiousness. 


89 


by  a  patient  in  the  act  of  coughing,  was  soon  affected 
with  a  violent  laryngeal  inflammation. 

In  1826  a  boy,  affected  with  frost-bites  of  his  foot, 
had  a  painful  diptheritic  inflammation  of  the  great  toe, 
soon  after  using  a  bath  that  had  been  employed  for  a 
diptheritic  patient. 

M.  Bretonneau  concludes  from  his  experiments  and 
observations,  that  the  disease  can  not  be  occasioned  by 
atmospheric  communication,  and  is  not  therefore  con¬ 
tagious  ;  but  that  its  cause  is  transmissible  by  inocula¬ 
tion,  and  is  therefore  strictly  infectious.  And  his 
observations  are  corroborated  by  other  authors. 

But,  on  the  other  hand,  Prof.  Trosseau,  who  inocu¬ 
lated  himself  and  two  of  his  pupils  with  diptheritic 
matter,  failed  to  produce  any  results  whatever ;  and 
Dr.  Harley,  of  London,  was  equally  unsuccessful  in 
experiments  on  domestic  animals. 

The  experience  of  M.  Isambert,  of  Paris,  as  related 
in  a  communication  on  the  epidemic  of  malignant  sore 
throat  which  occurred  in  Paris  in  1855,  goes  to  prove 
that  diptheria  is  contagious  as  well  as  infectious.  Pie 
says  :  u  Diptheritic  affections  sometimes  appear  spo¬ 
radically  ;  they  also  often  seem  to  be  endemic,  as  well 
as  epidemic  and  contagious.  As  predisposing  causes, 
we  may  consider  that  the  lymphatic  temperament,  a 
feeble  constitution,  privation,  etc.,  all  exert  a  decided 
influence.  Youth  is  much  more  exposed  to  the  disease 
than  any  subsequent  age.  Locality  and  overcrowding 
have  a  positive  effect ;  so  also  do  cold  and  changeable 
seasons. 

“  Epidemic  influences  are  much  the  most  powerful. 
As  to  the  contagious  nature  of  the  disease  there  can  be 
no  doubt,  since  many  physicians  have  contracted  it. 
The  opinion  of  M.  Bretonneau,  that  diptheria  is  not 


90 


Diptheria. 


transmitted  by  the  atmosphere,  but  is  always  the  result 
of  inoculation,  is  altogether  too  exclusive.  With  M. 
Trosseau,  we  can  not  reject  infection  at  a  distance 
as  one  of  the  means  of  propagation  possessed  by 
diptheria.” 

That  the  prevalence  of  the  disease  depends  quite  as 
much  on  the  condition  of  the  inhabitants  as  upon  the 
moisture  or  temperature  of  the  atmosphere,  or  even 
upon  the  vague  and  indefinite  u  epidemic  influence,”  so 
much  talked  of  and  so  little^  understood,  is  shown  by 
the  following  facts  adduced  by  M.  Trosseau  :  “  In  the 
villages  of  the  Loire,  remarkable  for  their  salubrity 
and  for  their  excellent  position,  I  have  seen  diptheria 
prevail  to  a  terrible  extent,  while  the  villages  of 
Sologne,  situated  in  the  midst  of  marshes,  remained 
exempt ;  and,  again,  hamlets  bordering  on  ponds  de¬ 
populated  by  the  epidemic,  while  others  enjoyed  a 
complete  immunity.” 

And  so,  too,  I  have  known  the  most  malignant  and 
putrid  forms  of  typhoid  fevers  and  of  dysentery,  and 
of  erysipelas,  and  of  scarlatina,  as  well  as  diptheria, 
prevail  in  the  most  salubrious  places  in  Hew  England 
and  Hew  York,  and  in  as  healthful  localities,  probably, 
as  the  sun  ever  shone  upon.  And  there,  as  elsewhere, 
I  suspect  the  essential  causes  are  to  be  found  chiefly 
in  the  habits  of  the  people.  The  epidemic  influence  is 
within  the  vital  domain  itself,  instead  of  the  atmos¬ 
phere  without. 

Dr.  Samuel  Bard,  as  well  as  nearly  all  the  writers 
of  the  seventeenth  century,  considers  the  disease  to  be 
infectious.  He  says  :  “  The  disease  I  have  described, 
appeared  to  me  to  be  of  an  infectious  nature,  and  as 
all  infection  must  be  owing  to  something  received  into 
the  body,  this,  therefore,  whatever  it  is,  being  drawn 


Ijxfectiotjsness. 


91 


in  by  the  breath  of  a  healthy  child,  irritates  the 
glands  of  the  fauces  and  trachea  as  it  passes  by  them, 
and  brings  about  a  change  in  their  secretions.  The 
infection,  however,  did  not  seem,  in  the  present  case, 
to  depend  so  much  on  any  generally  prevailing  dis¬ 
position  of  the  air  as  upon  effluvia  received  from  the 
breath  of  infected  persons.  This  will  account  why  the 
disorder  should  go  through  a  whole  family  and  not 
affect  the  next-door  neighbor.” 

Dr.  Ranking,  in  his  late  lectures  on  diptheria,  has 
probably  presented  the  subject  of  its  contagiousness  or 
infectiousness  in  the  true  light.  He  remarks :  “  My 
own  conviction  is,  that  it  is  infectious  to  a  limited 
degree  ;  by  which  I  mean,  that  when  patients  are 
accumulated  in  small,  ill-ventilated  rooms,  the  disease 
is  likely  to  be  communicated  ;  but  I  do  not  fear  that, 
like  scarlatina  or  erysipelas,  it  may  be  propagated  in 
spite  of  all  sanitary  precautions.  Still  less  that  the 
infection  can  be  conveyed  by  the  clothes  or  persons  of 
those  who  visit  or  superintend  the  patients.  That  it 
commonly  spreads  through  the  family  once  invaded  is 
to  be  attributed,  in  some  degree,  to  the  persistence  of 
the  same  cause  as  originated  the  first  case.” 

Dr.  Edward  Ballard,  of  Islington,  in  an  article  pub¬ 
lished  in  the  Medical  Times  and  Gazette ,  July  23, 
1857,  adduces  the  following,  among  other  facts,  in 
support  of  the  infectious  character  of  diptheria  :  “  In¬ 
fectious  diseases  habitually  spread  in  families  they 
invade.  Out  of  forty-seven  families  there  were  only 
fifteen  in  which,  the  other  members  all  remained 
healthy.  Of  course  it  may  be  argued,  in  opposition, 
that  all  the  members  of  a  family  are  equally  exposed 
to  the  operations  of  local  causes  of  disease.  As  a  rule, 
diptheria  spread  in  the  houses  it  invaded,  chiefly 


92 


Dipthekia. 


among  those  members  of  tlie  several  families  who 
were  most  closely  in  communication.  In  no  case 
where  separation  from  the  sick  person  had  been  effect¬ 
ed  early  in  the  disease,  have  I  noticed  that  it  has  spread 
to  the  separated  individuals.” 

Although  we  admit  that  persons  affected  with  dip- 
theria  may  communicate,  under  favoring  influences, 
the  causes  of  the  disease  to  others,  it  must  be  obvious 
that  whatever  local  or  other  causes  occasion  it  in  any 
one  member  of  a  family,  are  also  liable  to  induce  it  in 
all  the  rest,  quite  independently  of  contagion  or  infec¬ 
tion.  And  in  point  are  the  results  of  inquiries  institu¬ 
ted  in  fifty-seven  houses  where  fatal  cases  have 
occurred  :  “  In  more  than  half  of  these  houses  there 
was  some  defect  in  the  sanitary  arrangements,  or  in 
the  surrounding  conditions  of  the  patient.  In  the 
greater  number  of  the  houses  thus  deficient,  the  fault 
was  discovered  in  the  state  of  the  drainage.” 

j Per  contra  we  have  an  equally  formidable  array  of 
medical  authorities  who  contend  that  diptheria  is  not 
infectious  at  all,  and  but  feebly  if  at  all  contagious. 

M.  Daviot,  who  has  written  a  memoir  on  the  dis¬ 
ease,  declares  that  he  has  never  met  with  an  instance 
where  it  was  communicated  by  personal  intercourse  ; 
and  that  neither  the  attendants  nor  those  who  cauter¬ 
ized  the  throats  of  affected  children  contracted  the  dis¬ 
ease.  Negative  testimony,  however,  should  have  but 
little  weight  against  positive.  What  one  physician 
has  seen  is  not .  to  be  disproved  by  what  another  has 
not  observed.  A  disease  may  be  infectious  or  conta¬ 
gious,  and  prevail  in  different  places  and  under  differ¬ 
ent  circumstances  in  the  same  place,  epidemically, 
endemically,  or  sporadically.  All  persons  who  are 
brought  in  contact  with  patients  affected  with  small- 


Infectiousness. 


93 


pox,  measles,  or  syphilis,  do  not  have  the  disease  ;  and 
it  not  unfrequently  happens  that  only  one  person  in  a 
neighborhood  will  have  small-pox,  measles,  whooping- 
cough,  mumps,  etc. 

Dr.  Crighton,  of  Edinburgh,  treated  forty-five  cases 
of  diptheria,  of  which  nine  resulted  fatally  ;  and  in 
reporting  the  cases  he  remarks  :  u  In  only  two  cases 
was  there  anything  like  proof  of  contagion,  and, 
from  all  that  I  have  seen  of  diptheria,  I  believe  that, 
although  it  would  be  incorrect  to  separate  it  from  the 
list  of  communicable  diseases,  yet  it  is  very  feebly  so 
compared  with  many  others.  I  may  mention  one 
instance  which  struck  me  particularly,  where,  in  a 
large  family  of  six  or  seven  children,  and  chiefly  under 
the  age  of  twelve,  a  child  had  the  disease  in  a  very 
severe  form,  and  although  he  wTas  never  isolated  during 
the  day  from  the  others,  hut  lay  on  a  sofa  in  a  room 
where  I  generally  found  several  of  them  at  my  visit, 
they  all  escaped.” 

Dr.  Monkton,  of  Kent,  England,  who  has  had  a 
large  experience  in  diptheria,  reports  through  the  Med¬ 
ical  Times  and  Gazette  of  February  26th,  1851 :  “  ETo 
decisive  instance  of  the  communicability  of  the  disease 
has  come  before  me ;  on  the  contrary,  I  have  seen  it 
attack  individuals  only,  in  a  family  of  liable  persons, 
much  more  frequently  than  I  think  scarlet  fever  would 
have  done.  My  own  conviction  is,  that  diptheria  is 
ejfidemic,  endemic  (i.  e .,  largely  affected  by  locality), 
and  non-contagious,  or,  if  contagious  at  all,  vastly  less 
so  than  scarlet  fever,  from  which  it  is  very  distinct.” 

Dr.  Slade  remarks :  “  Kow,  although  those  who  favor 
the  idea  of  contagion  find  in  the  phenomena  of  cuta¬ 
neous  diptheria  strong  ground  for  the  support  of  the 
theory  of  inoculation,  there  are  facts  which  wTould 


94 


Diptheria. 


equally  seem  to  oppose  it.  For  example  :  it  has  been 
observed  in  these  epidemics  that  the  false  membrane 
upon  the  skin  not  only  presents  itself  in  those  not  pre¬ 
viously  affected  with  faucial  diptheria,  but  it  not  un- 
frequently  attacks  remote  parts,  such  as  we  should  sup¬ 
pose  were  inaccessible  to  inoculation,  as,  for  example, 
the  folds  of  the  groins  in  children,  and  the  spaces  be¬ 
tween  the  toes.  A  single  well-observed  fact  of  this 
kind  is  sufficient  to  cast  a  doubt  on  the  theory  of  in¬ 
oculation.” 

On  the  subject  of  the  communicability  of  the  dis 
ease,  Dr.  Greenhow  remarks  :  “  Although  I  have  no 
proof  that  diptheria  is  communicable  by  means  of  the 
exudation,  many  facts  have  fallen  under  my  notice 
which  convince  me  that  the  disease  is  in  some  way  or 
other  communicable.  I  attach  little  importance  to  the 
circumstance  that  diptheria  so  often  attacks  simulta¬ 
neously,  or  at  short  intervals,  several  members  of  the 
same  family ;  such  facts  may  be  explained  on  the  sup¬ 
position  that  the  patients  have  in  such  instances  been 
all  exposed  to  one  common  cause,  be  it  endemic  or  epi¬ 
demic.  But  if,  soon  after  the  arrival  of  a  patient  from 
an  infected  district,  diptheria  should  break  out  in  a 
place  where  it  did  not  previously  exist,  and  attack  per¬ 
sons  who  have  been  in  direct  communication  with  the 
invalid,  and  especially  if  it  attack  only  such  persons, 
then  have  we  the  strongest  presumptive  evidence  of  its 
being  a  contagious  disease.” 

The  facts  already  adduced — and  a  multitude  of 
similar  ones  could  be  easily  collated — prove  to  my 
mind,  most  clearly,  that  diptheria  originates  indige¬ 
nously,  and  that  it  may  be  communicated,  under  pe¬ 
culiar  circumstances,  from  one  person  to  another. 


Causes. 


95 


CAUSES  OF  DIPTHERIA. 

On  no  subject  is  medical  literature  more  crude, 
vague,  unsatisfactory,  and  irrational  than  in  relation 
to  the  causes  of  disease.  And  this  must  ever  be  the 
case  so  long  as  the  medical  profession  confesses  pro¬ 
found  ignorance  of  the  essential  nature  of  disease. 
When  this  primary  problem  is  solved,  when  medical 
men  understand  what  disease  is,  they  will  not  be  long 
in  comprehending  the  causes  which  produce  it,  at  least 
with  sufficient  accuracy  and  exactitude  for  all  practical 
purposes. 

For  hundreds  of  years  the  profession,  in  its  investi¬ 
gations  of  the  causes  of  disease,  the  nature  of  disease, 
and  the  remedies  for  disease,  has  been  pursuing  a  mere 
phantom.  Medical  men  have  assumed  that  diseases 
have  specific  characters  or  natures  inherent  in  them¬ 
selves,  and  that  therefore  each  must  have  a  specific 
cause,  and  require  a  specific  remedy.  There  can  be 
no  greater  delusion.  And  when  we  reflect  for  a  single 
moment  that  disease — that  all  disease — is  the  action 
of  the  living  system  to  resist  poisons,  expel  impurities, 
or  to  repair  damages ;  that  it  is  purely  and  simply  a 
defensive  or  remedial  struggle — vital  action  in  relation 
to  things  abnormal — this  whole  doctrine  of  specifics 
will  appear  sufficiently  absurd. 

There  are  but  two  sources  of  disease,  aside  from  me¬ 
chanical  injuries  or  irritants,  and  there  are,  as  was  ex¬ 
plained  by  Hippocrates  nearly  three  thousand  years 
ago,  poisons  introduced  from  without,  or  impurities 
generated  within.  If  we  inhale  miasms  or  particles 
of  foreign  substances  which  float  in  the  atmosphere, 
or  if  we  absorb  them  through  the  skin,  or  if  we  take 


96 


Diptheria. 


them  into  the  stomach  in  the  shape  of  aliments,  condi¬ 
ments,  or  medicines,  the  blood  becomes  impure  and 
the  capillary  vessels  obstructed.  Or  if  the  waste  or 
effete  matters  of  the  system — the  ashes  or  debris  of  the 
disintegrated  tissues — are  not  properly  deterged  by  the 
various  emunctories,  impurities  are  ingenerated  ;  that 
is  to  say,  the  effete  matters  which  should  have  been 
expelled  are  retained,  causing  obstructions,  and  thus 
becoming  the  occasions  or  causes  of  disease ;  the  dis¬ 
ease  itself,  let  it  never  be  forgotten,  is  the  effort  of  the 
living  system  to  remove  these  obstructions. 

The  particular  form  of  disease,  the  manner  in  which 
the  remedial  effect,  or  the  process  of  purification  will 
be  manifested,  must  depend  on  a  variety  of  circum¬ 
stances  and  conditions — the  nature  and  quantity  of  the 
obstructing  materials,  the  absolute  and  relative  vigor 
and  integrity  of  the  various  depurating  organs,  the 
habits  of  the  patient,  atmospheric,  electrical,  thermo- 
metrical,  and  passional  influences,  etc. 

We  are  taught  in  medical  books  that  certain  diseases 
have  inherent  dispositions  or  tendencies  to  impress  or 
act  upon  particular  parts  of  the  system,  or  to  locate  in 
certain  organs,  or  to  seat  themselves  here  or  there,  or  to 
run  through  the  system,  etc.,  etc.,  all  of  which  vaga¬ 
ries  are  founded  on  a  false  notion  of  the  nature  of 
disease. 

Dr.  Jacob  Bigelow,  of  Boston,  who  claims  the  honor 
of  being  the  father,  or  at  least  one  of  the  fathers  of  the 
modern  doctrine  of  “  self-limited”  diseases,  gives  us, 
in  a  late  work  (“  Nature  in  Disease”)  the  following 
lucid  exposition  of  the  subject:  “  By  a  self-limited 
disease,  I  would  be  understood  to  express  one  which 
receives  limit  from  its  own  nature ,  and  not  from  foreign 
influences ;  one  which  after  it  has  obtained  a  foothold 


Causes.  97 

in  the  system,  can  not,  in  the  present  state  of  our 
knowledge,  be  eradicated  or  abridged  by  art.” 

If  disease  is  really  an  independent  entity,  a  thing, 
a  foreign  substance,  a  something  outside  of  the  living 
organism,  a  being  or  creature  analogous  to  a  ghost  or 
goblin,  imp  or  sprite,  fiend  or  demon,  spook  or  spirit, 
such  reasoning  might  be  the  very  quintessence  of  med¬ 
ical  philosophy.  But  if  disease  is  in  fact  nothing  of 
the  sort ;  if  it  be  the  exact  contrary,  if  the  disease  and 
the  ms  medicatrix  naturae  be  one  and  the  same  thing, 
as  I  hold  to  be  true  and  demonstrable,  then,  in  the 
light  of  this  truth,  nothing  can  be  more  ridiculously 
nonsensical  than  Dr.  Bigelow’s  explanation  of  a  self¬ 
limited  disease.  Disease  is  represented,  by  the  learned 
Doctor,  as  a  creature  or  thing  which  has  obtained  a 
“  foothold”  in  the  system,  and  after  having  established 
itself  in  the  vital  domain,  it  then  ordains  for  itself 
a  law  of  limitation,  and  receives  limits  from  its  own 
nature.  Is  there  not  something  incomprehensibly 
queer  in  the  idea  of  a  disease  taking  forcible  posses¬ 
sion  of  a  living  body,  then  dictating  to  itself  laws  and 
limits,  affixing  to  itself  boundaries  of  time  and  space, 
selecting  the  place  of  its  abode,  and  determining  just 
how  long  it  will  stay  or  go,  or  exist,  or  remain,  or  run, 
or  be  seated,  or  where,  and  when,  and  how,  and  why 
it  will  consent  to  be  unseated,  and  utterly  refusing  to 
be  “  eradicated  or  abridged”  by  the  art  of  dealing  out 
all  the  drugs  of  the  apothecary  shop  ? 

The  error  lies  further  back.  It  consists  in  mistaking 
the  relations  of  living  and  dead  matter.  Medical 
books  and  schools  teach  that  the  causes  of  disease  act 
or  make  impressions  on  the  living  organism,  and  that 
diseases  do  the  same,  and  that  remedial  agents  do 
the  same.  The  reverse  of  all  this  is  the  truth,  as 

5 


08 


Diptheeia. 


taught  in  the  Book  of  Nature  and  in  the  School  of  the 
Universe. 

As  a  general  statement,  poisons,  impurities,  or  or¬ 
ganic  lesions  are  the  direct  or  immediate  causes  of 
all  diseases,  and  unphysiological  habits  or  conditions 
are  the  causes  of  these  causes — the  remote  or  predis¬ 
posing  causes  of  disease.  But  it  is  very  difficult  to 
detect  the  nature  or  properties  of  those  poisons  or  im¬ 
purities— morbific  materials — which  result  from  the 
changes,  transformations,  and  decompositions  of  or¬ 
ganic  matter.  They  elude  all  the  art  of  the  chemist, 
all  the  skill  of  the  anatomist,  and  defy  the  vision  of 
the  microscopist.  An  almost  inappreciable  quantity 
of  variolous  matter,  for  example,  applied  to  any  part 
of  the  living  body  denuded  of  its  cuticle,  will  occasion 
a  violent  fever  attended  with  a  pustular  exanthema  over 
the  whole  surface  ;  yet  the  analytical  chemist  has  never 
been  able  to  ascertain  the  constituent  elements  of  that 
virus.  And,  indeed,  chemistry  never  has  been  and  never 
will  be  able  to  determine  the  exact  composition  of  any 
organic  product,  whether  it  be  food,  tissue,  effete  mat¬ 
ter,  secretion,  excretion,  poison,  or  virus,  for  the  reason 
that,  in  the  process  of  analysis,  some  of  the  elements 
are  changed  or  lost.  Chemistry  can  determine  what 
remains  as  the  result  of  the  analysis,  and  this  is  all. 
And  when  chemists  undertake  to  tell  us  what  food  is, 
what  disease  is,  what  vitality  is,  what  living  tissue  is, 
or  what  remedies  are,  by  a  process  of  chemical  analy¬ 
sis,  they  are  entirely  out  of  their  proper  element. 
These  problems  are  all  to  be  determined  by  physiologi¬ 
cal  laws,  not  by  chemical  decompositions  ;  by  the  in* 
stincts  of  the  living  organism,  and  not  by  the  constitu¬ 
tion  of  dead  matter. 

In  croup,  and  in  diptheria,  and  in  certain  other  mor- 


/  3 

Causes.  99 

bid  conditions  of  tlie  system,  in  the  process  of  depu¬ 
rating  the  system  of  its  virus  or  impurities,  the  fibri¬ 
nous  or  albuminous  elements  of  the  blood  are  exuded 
upon  the  skin  or  upon  the  mucous  surfaces  ;  in  cholera, 
the  serum  of  the  blood  is  poured  into  the  intestinal 
tube ;  in  eruptive  fevers,  some  morbific  material  is  ex¬ 
pelled  through  the  skin ;  in  diabetis,  a  saccharine  ele¬ 
ment  is  deterged  copiously  through  the  kidneys  ;  in 
diarrhea,  fecal  matters  are  dejected  by  the  bowels;  in 
consumption,  tuberculous  matter  is  expelled  through 
the  pulmonary  structure ;  in  cholera  morbus,  vitiated 
and  acrid  bile  is  excreted  from  the  liver;  in  simple 
fevers,  effete  matters  of  various  kinds  are  determined 
with  more  or  less  force  to  one  or  more  of  the  depurat¬ 
ing  organs,  etc.  In  all  of  these  cases-— and  the  princi¬ 
ple  applies  to  all  diseases— the  form  of  the  disease  and 
the  nature  of  the  material  excreted  or  expelled,  de¬ 
pends  on — 1.  The  force  and  direction  of  the  remedial 
effort.  2.  The  organ  or  structure  through  which  the 
purifying  process  chiefly  takes  place.  3.  The  condi¬ 
tion  of  the  whole  mass  of  blood  at  the  time.  4.  The 
quantity  of  morbific  material  to  be  eliminated ;  and 
5.  The  external  influences  operating,  so  to  speak,  at 
the  time,  as  temperature,  humidity,  etc. 

Much  has  been  said  and  written  on  the  influence 
which  meteorological  and  cosmic  conditions  exert  in 
the  production  of  cholera,  diptheria,  and  other  pesti¬ 
lences  ;  but  the  whole  subject  is  scarcely  better  under¬ 
stood  now  than  it  was  before  the  sciences  of  meteor¬ 
ology  and  cosmogony  were  heard  of.  Bretonneau 
entertains  the  notion,  that  diptheria  could  only  be  de¬ 
veloped  in  a  damp  atmosphere.  But  in  the  recent 
epidemics  of  France  and  England,  the  disease  has  pre¬ 
vailed  in  high  and  dry  situations.  And  in  this  country 


100 


Dipthekia. 


I  am  not  aware  of  any  facts  which  tend  to  prove  that 
it  is  more  prevalent  or  more  severe  in  damp  localities 
than  in  dry.  In  California,  noted  for  its  very  dry, 
summer  atmosphere,  according  to  Dr.  Wooster,  the 
disease  has  been  very  prevalent  and  very  fatal.  Dr. 
Wooster  states,  in  a  monograph  on  diptheria  : 

“  In  our  climate,  the  air  in  summer  becomes  so  dry, 
that  if  an  ordinary  soft  wmoden  pail  or  bucket  be  half 
filled  with  water,  and  set  in  the  sun  in  the  open  air 
for  six  hours,  and  then  two  quarts  of  water  be  added, 
it  will  leak  through  the  joints  of  the  shrunken  staves, 
above  the  surface  of  the  first  portion  of  water.  A 
miner  uses  a  bucket  to  bail  water  from  a  hole  all  the 
forenoon,  and,  although  it  is  perfectly  saturated  with 
water,  yet  if  he  leaves  it  in  the  sun  while  he  goes  to 
his  dinner,  when  he  returns  it  will  often  fall  to  pieces 
as  he  attempts  to  take  it  up. 

“  This  is  the  kind  of  air  in  which  the  disease  has  oc¬ 
curred  with  unequaled  fatality  in  this  State.  In  this 
city  I  can  not  ascertain  that  a  case  has  occurred  in  that 
part  of  the  town  built  over  or  near  the  waters  of  the 
bay,  or  on  the  salt  marshes  near  it.  But  I  have  seen 
cases  in  the  high  part  of  the  city,  and  on  bluff  head¬ 
lands  extending  into  the  bay,  points  that  from  their 
elevation  and  constant  exposure  to  a  strong  breeze 
would  be  thought  inaccessible  by  any  morbid  [mor¬ 
bific  ?]  effluvia.” 

It  should  be  considered  here,  that  the  inhabitants  of 
high  and  dry  situations  may  live  in  the  line  of  the 
currents  of  wind  which  convey  the  miasms  of  the  low 
and  wet  localities,  and  hence,  although  their  situations 
are  in  themselves  perfectly  salubrious,  the  people  resid¬ 
ing  there  may  be  really  more  exposed  to  miasmatic 
diseases  than  are  the  people  who  dwell  in  the  more  hu- 


Causes. 


101 


mid  atmosphere  of  the  lowlands,  out  of  the  direction 
of  the  prevailing  winds. 

According  to  Mr.  Ernest  Hart,  the  diptheria  has  ap¬ 
peared  in  France  and  in  England  with  no  regard  what¬ 
ever  to  any  recognized  climatic  or  meteorological  laws. 
It  has  visited  the  open  hamlets  of  the  rural  depart¬ 
ments,  and  the  crowded  courts  of  the  great  cities ;  it 
has  prevailed  at  the  sea-side ;  in  the  heat  of  summer  ; 
during  the  cold  of  winter ;  in  marshy,  ill-drained  local¬ 
ities  ;  in  dry  and  elevated  regions ;  in  ill-ventilated 
barracks,  and  in  the  open  country;  in  dry  places ;  in 
damp  places ;  in  the  low  valleys,  and  on  the  high 
mountains. 

There  is  truth — practical  truth — in  the  following 
paragraph :  “  Zymotic  in  its  nature,  it  tends  to  fasten 
upon  whomsoever  is  debilitated  by  previous  disease, 
or  by  a  constitution  naturally  feeble  and  artificially 
effeminized,  or  where  vitality  is  lowered  by  the  de¬ 
pressing  influences  of  luxury,  indolence,  and  inactiv¬ 
ity  ;  and  the  habitual  defiance  of  physical  and  hygie¬ 
nic  laws,  which  is  so  frequent  an  element  in  fashion¬ 
able  life.  Hence  individual  cases  come  into  play,  and 
introduce  this  associate  of  the  poor  into  the  palaces 
and  mansions  of  the  great,  which  they  so  often  fringe. 
Diptheria  finds  there  its  victims  pale  and  anemic,  or 
grossly  sanguineous  and  unhealthily  excited.” 

“  Grossly  sanguineous  !”  Bad  blood  is  the  essential 
condition  of  all  putrescent,  pestilential,  and  malignant 
diseases,  and  gross  living  is  the  essential  cause  of  bad 
blood.  And  when  we  investigate  the  etiology  of  dip¬ 
theria  to  its  starting-point,  I  suspect  we  shall  find  that 
impure  or  indigestible  food,  with  inattention  to  per¬ 
sonal  cleanliness — the  chief  sources  of  impure  blood 
and  foul  secretions — are  the  essential  causes  of  diptheria. 


102 


Diptheeia. 


Mor  can  I  forbear  alluding  in  this  place  to  what  I 
can  not  help  regarding  as  standing  at  the  very  head 
of  the  u  specific57  causes  of  this  disease — swine  raising 
and  pork  diet.  That  the  flesh  and  grease  of  that  fil¬ 
thy  scavenger,  the  hog,  in  the  form  of  pork,  ham,  sau¬ 
sages,  lard,  etc.,  constitute  a  most  impure  and  blood- 
poisoning  aliment,  I  believe  no  intelligent  physiologist 
will  deny.  And  that  a  sty-fed  hog  is  a  diseased  car¬ 
cass,  is  evident  to  all  pure  senses.  That  pork  and 
scrofula  stand  to  each  other  in  the  relation  of  cause 
and  effect,  has  been  proverbial  among  observing  men 
for  centuries.  Yet  all  over  this  Christian  land  some 
form  of  sty-fed  and  sty-fattened  hog-food  is  one  of  the 
most  common,  most  cherished,  and  most  relished 
dishes  to  be  found  on  the  tables  of  the  rich  or  q>oor ; 
while  in  an  ordinary  hotel,  boarding-house,  or  restau¬ 
rant,  or  even  in  a  private  family,  but  few  articles  of 
food  can  be  found  not  attainted  with  some  part  or  por¬ 
tion  of  the  tissue  or  adipose  matter  derived  from  this 
disgusting  animal. 

Within  a  few  months  I  have  visited  and  lectured  in 
different  States — Maine,  Massachusetts,  Illinois,  Indi¬ 
ana,  Iowa,  Ohio,  and  in  the  District  of  Columbia — and 
in  all  places  I  inquired  particularly  as  to  the  preva¬ 
lence  of  diptheria,  and  also  as  to  the  dietetic  habits  of 
the  people,  especially  with  regard  to  pork-eating.  In 
each  State  which  I  visited  I  heard  of  places  where  the 
disease  had  been  very  prevalent  and  very  fatal,  and  in 
all  of  these  places  swine-food  was  employed  very  free¬ 
ly,  as  was  swine-grease,  as  shortening  for  pastry,  cakes, 
biscuit,  and  even  bread. 

But  pork-breeding  as  well  as  pork- eating  conduces 
to  this  as  well  as  to  other  foul  and  malignant  epidem¬ 
ics.  And  I  am  of  opinion  that  all  of  the  contagious 


Mortality. 


103 


diseases  in  the  world  originate  from  slaughter-houses, 
hog-pens,  distilleries,  barn-yards,  stables  and  henneries, 
provision  depots,  etc.,  where  animal  offal  and  excre¬ 
ments  accumulate,  and  where  animal  matter  is  con¬ 
stantly  undergoing  decomposition  and  putrefaction, 
thus  loading  the  atmosphere  with  miasms  and  impuri¬ 
ties.  If  the  people  would  all  become  vegetarians,  there 
would  he,  in  my  opinion,  an  end  at  once  of  such  dis¬ 
eases  as  eruptive  fevers,  and  of  contagious  diseases  of 
every  sort. 

Persons  who  do  not  eat  pork,  but  who  dwell  in 
close  proximity  to  piggeries,  may  become  infected 
with  the  seeds  of  diptheria  or  some  other  foul  disease. 
The  very  atmosphere  is  poisoned  with  the  effluvia 
which  constantly  emanates  from  the  lungs  and  skin  and 
excrement  of  the  animal,  so  that  one  who  abhors  the 
unclean  aliment  may  be  destroyed  by  inhaling  the 
miasms  which  the  noxious  animal  generates,  as  one 
who  does  not  smoke  cigars  nor  chew  tobacco  may  be 
nauseated  and  sickened  by  the  breath  and  atmosphere 
which  are  rendered  poisonous  and  pestilential  by  those 
who  do  smoke  and  chew. 

MORTALITY  OF  DIPTHERIA. 

The  mortuary  statistics  of  no  disease  present  greater 
diversity  of  results  than  those  of  diptheria.  This  may 
be  accounted  for,  in  part,  by  the  great  diversity  of  cir¬ 
cumstances  under  which  the  disease  prevails,  and  the 
different  habits  and  constitutions  of  the  persons  who 
are  the  subjects  of  it.  Much,  however,  is  due  to  the 
course  of  medical  treatment  adopted.  And  I  fear 
that  a  careful  investigation  of  this  branch  of  our  sub¬ 
ject  would  disclose  another  evidence  of  the  truth  of 


104 


Diptheria. 


the  saying,  “Justin  the  ratio  that  doctors  and  dings 
have  increased,  diseases  and  deaths  have  multiplied.” 
So  far  as  I  have  been  able  to  collect  statistics  bearing 
upon  this  point,  I  find  no  exception  to  the  general  rule, 
that  the  mortality  of  diptheria  is  everywhere  in  pro¬ 
portion  to  the  potency  of  the  drug-medication. 

As  is  the  case  with  malignant  scarlet  fever,  croup, 
typhoid  pneumonia,  and  other  diseases  of  low  diathe¬ 
sis,  many  cases  will  bear  drug-treatment,  bleeding, 
blistering,  etc.,  which  are  not  benefited  by  them, 
while  in  the  most  severe  cases  their  administration  is 
almost  certain  death.  Physicians  have  often  noticed 
and  recorded  the  fact  that,  in  the  treatment  of  scarla¬ 
tina  maligna ,  a  single  dose  of  castor-oil,  or  a  moderate 
bleeding,  has  destroyed  the  life  of  a  patient  in  a  few 
hours.  But  in  the  milder  form  of  this  disease — scar¬ 
latina  simplex — the  patient  will  bear  repeated  bleed¬ 
ings  and  purgatives,  and  survive  both  the  disease  and 
the  medication.  These  remarks  apply  with  equal 
force  to  diptheria.  The  discordant  methods  of  prac¬ 
tice  to  which  different  physicians  have  resorted,  and 
the  disagreements  of  medical  men  of  extensive  observ¬ 
ation  and  large  experience,  with  regard  to  what  is 
useful  or  injurious  in  its  treatment — some  authors  con¬ 
demning  as  aggravating  the  disease  and  endangering 
the  life  of  the  patient  the  very  remedies  and  measures 
which  others  rely  upon  as  essential  to  the  cure — render 
an  estimate  of  the  necessary  or  even  actual  mortality 
of  the  disease  itself,  independent  of  treatment,  a  very 
difficult  matter  to  determine.  In  their  reports  of  cases, 
medical  men  almost  universally  assume  that  all  patients 
who  recover  are  indebted  for  their  lives  to  the  drugs 
and  doses  administered  by  the  physician.  But  this  is  by 
no  means  a  logical  conclusion.  It  may  be  that  patients 


Mortality. 


105 


recover  in  spite  of  the  medicine,  rather  than  with  its 
assistance.  And  this  I  believe  to  be  the  general  if  not 
the  universal  rule,  so  far  as  drug-medication  is  con¬ 
cerned.  Medical  reasoning  is  unlike  all  other  reason¬ 
ing.  It  seems  to  disregard  all  the  ordinary  rules  of 
logic  ;  and  medical  men  have  a  method  of  ratiocination 
peculiarly  professional  and  exclusively  medical.  They 
claim  that  their  remedies  have  a  power  over  the  vital 
functions,  and  that  they  are  capable  of  controlling 
morbid  actions ;  and  when  a  patient  recovers,  the 
remedies  employed  are  accredited  with  the  cure.  But, 
suppose  the  patient  dies  ?  what  then  ?  Do  these  med¬ 
ical  logicians  charge  the  killing  to  the  medicine  ? 
hTever.  The  patient  dies  in  spite  of  it.  This  is  not  legit¬ 
imate  logic.  It  is  just  as  rational  to  assume  that  when 
the  patient  dies,  the  medicine  kills  him,  as  to  assume 
that  when  the  patient  recovers,  the  medicine  cures  him. 
Indeed,  this  is  the  more  reasonable  assumption,  because 
the  relation  of  the  drug  to  the  living  organism  is  that 
of  a  poison  ;  its  tendency  is  to  kill. 

These  views  are  corroborated  by  the  observations 
which  I  have  had  the  opportunity  to  make  in  various 
parts  of  the  country,  with  regard  to  the  results  of 
Hygienic  and  of  drug  treatment.  In  all  cases  where 
little  or  no  medicine  was  employed,  the  per  centage  of 
deaths  was  very  small.  In  all  cases  where  active  drug 
treatment  was  resorted  to,  the  proportion  of  deaths  was 
large.  In  some  places  where  the  disease  has  prevailed 
endemically,  every  case  has  been  treated  hygienically, 
without  the  loss  of  a  single  patient ;  while  in  other 
places,  all  the  cases  have  been  treated  with  the  ordinary 
drug  remedies,  and  all  have  died. 

These  extreme  results  surely  mean  something ;  and 
before  we  can  determine  diptheria  to  be  a  dangerous 

5* 


106 


Diptheria. 


disease,  per  se ,  we  must  understand  the  effects  of  the 
various  methods  of  treatment  brought  to  hear  upon  it, 
or  upon  the  patient. 

While  lecturing  in  Boston,  recently,  I  met  with  Dr. 
JPrescott,  of  Farmington,  Me.,  who,  after  an  experience 
of  forty  years  of  drug-medication,  came  to  the  same 
conclusion  that  Prof.  Jos.  M.  Smith,  of  the  Yew  York 
College  of  Physicians  and  Surgeons,  has  recently 
arrived  at,  that  “  drugs  do  not  cure  disease  ;  disease 
is  always  cured  by  the  vis  medicatrix  naturae  and  to 
the  conclusion  that  Prof.  Alonzo  Clark,  of  the  same 
school,  not  long  since  announced  to  the  medical  class, 
viz.  :  “  All  of  our  medicines  are  poisonous,  and,  as  a 
consequence,  every  dose  diminishes  the  patient’s  vital¬ 
ity  and  who,  acting  in  accordance  with  his  honest 
convictions  of  truth  and  duty,  renounced  drug-medica¬ 
tion  and  adopted  the  Hygienic,  which  system  he  has 
advocated  and  practiced  ever  since. 

Dr.  Prescott  informed  me  that  in  one  of  the  adjoin¬ 
ing  towns,  of  thirty-five  cases  of  diptheria,  thirty 
terminated  fatally.  Of  course  these  cases  were  treated 
with  the  ordinary  remedies.  Dr.  Prescott  has  himself 
treated  several  cases  hygienically,  and  has  lost  but  one. 
In  October  last,  I  visited  and  lectured  in  Augusta  and 
in  Yassalboro’,  Me.,  and  there  learned  the  statistics  of 
the  mortality  of  the  disease  as  it  had  prevailed  in 
various  parts  of  the  State.  The  whole  number  of 
deaths  was  about  one  half  of  all  the  cases,  although 
the  mortality  varied  in  different  places  from  twenty  to 
seventy-five  per  cent.  In  one  town — Canton,  if  I 
recollect — of  twenty  cases,  sixteen  were  fatal.  In  a 
few  instances  the  friends  of  the  patients  had  managed 
the  cases  as  well  as  they  could  with  “  water-treatment,” 
and  of  these  none  were  lost.  During  a  lecturing  ex- 


Mortality. 


107 


cursion  in  December  and  January  last,  in  some  parts 
of  Ohio,  Indiana,  Illinois,  and  Iowa,  I  beard  of  many 
places  in  which  the  disease  had  appeared,  and  the 
average  mortality  was  nearly  the  same  as  in  Hew 
England.  In  some  places  nearly  all  the  patients  died, 
and  in  other  places  a  very  small  proportion  of  the 
cases  were  fatal.  In  Sullivan  County,  H.  Y.,  where 
the  disease  prevailed  endemically,  as  I  have  already 
remarked,  all  the  cases  terminated  fatally.  And  in 
Orange,  Conn.,  according  to  the  report  of  the  attending 
physician — Dr.  Beardsley,  of  Milford — of  the  fifteen 
cases  which  occurred,  fourteen  were  fatal.  And  it 
may  not  be  irrelevant  to  remark  that,  being  on  a  pro¬ 
fessional  visit  in  the  neighborhood  of  Orange,  soon 
after  the  occurrence  of  the  endemic  in  the  place,  I  was 
informed  that  the  fifteenth  case — the  only  patient  who 
survived — removed  from  the  place,  and  from  the 
Doctor ,  so  soon  as  the  disease  attacked  him.  What 
relation  this  circumstance  had  to  the  recovery  is,  of 
course,  a  legitimate  question  for  differences  of  opinion. 

Dr.  Eougeaud,  in  a  monograph  on  a  terrible 
epidemic  which  prevailed  in  San  Francisco,  and  in 
other  towns  in  California  in  the  autumn  of  1856,  hav¬ 
ing  all  the  characters  of  pharyngeal  diptheria,  states 
that  the  mortality  was  appalling.  “  Few  children 
attacked  by  it  recovered.” 

In  the  city  of  Hew  York  no  record  of  death  of  dip¬ 
theria  is  to  be  found  anterior  to  1857,  and  in  that  year 
only  two  cases  are  recorded.  In  1858  only  five  cases 
were  reported  to  the  Inspector’s  office.  In  1859  the 
cases  had  increased  to  fifty-three,  and  in  1860  four 
hundred  and  twenty-two  deaths  were  reported  ;  since 
which  the-  mortality  has  averaged  about  fifteen  per 
wreek. 


108 


Diptheria. 


During  the  last  two  years,  newspaper  accounts  have 
come  to  us  from  more  than  a  hundred  places  in  the 
United  States,  stating  that  families  had  lost  three, 
four,  five,  six,  seven,  and  even  more  members  of  the 
disease,  and  in  not  a  few  instances  all  of  the  members 
of  the  family  have  died.  And  during  this  time  I  have 
received  some  hundreds  of  communications,  asking 
for  information  respecting  the  proper  Hygienic  treat¬ 
ment  of  the  disease,  of  whose  nature  and  contents  the 
following  extracts  will  serve  as  samples  : 

Lacon,  Illinois,  Nov.  28,  1860, 

H.  T.  Trall,  M.D. — Dear  Sir :  Diptheria  is  raging 
all  around  us.  All  ages  are  having  it.  With  children 
it  is  very  fatal — all,  in  fact,  die.  The  people  in  this 
community  are  most  completely  blinded  by  drug- 
op  a  thy,  and  are  doctored  in  what  seems  to  my  com¬ 
mon  sense  to  be  the  most  outrageous  manner — blisters, 
turpentine,  quinine,  brandy,  beef-tea,  etc.,  etc.  I  have 
read  what  you  have  written  on  the  subject  in  the  Wa¬ 
ter- Cure  Journal.  Myself  and  wife  have  been  among 
it  constantly,  and’  so  far  we  keep  well,  as  do  our  five 
children.  S.  S.  H. 

Sandwich,  Mass.,  Jan .  16,  1861. 

Dr.  Trall — Dear  Sir :  The  diptheria  has  made  its 
appearance  on  all  sides  of  us,  but  has  not  yet  entered 
our  village,  though  a  widow  lady,  who  moved  from 
our  town  some  months  since,  has  lately  brought  here 
for  interment  the  remains  of  four  children,  the  victims 
of  the  new  disease.  Under  the  circumstances,  I  very 
naturally  feel  a  little  anxious  for  my  only  child,  a  boy 
of  nine  years  of  age,  for,  should  he  be  attacked  with 
the  disease,  I  should  be  very  loth  to  subject  him  to  the 
tender  mercies  of  the  regular  system  of  practice.  I 


Mortality. 


109 


wish  to  treat  him  hydropathically  should  occasion  re¬ 
quire,  and  to  that  end  I  desire  such  information  and 
advice  as  you  can  give  me..  I  should  perhaps  state 
that  I  am  a  humble  mechanic,  yet  I  trust  with  suffi¬ 
cient  common  sense  to  understand  the  rationale  of  wa¬ 
ter-cure  ;  for,  guided  by  the  instructions  of  your  “  Hy¬ 
dropathic  Encyclopedia,”  I  have  been  able  for  several 
years  to  dispense  entirely  with  drug-medicines,  and 
with  the  advice  of  physicians. 

The  reports  of  physicians  who  claim  remarkable 
success  in  the  treatment  of  diptheria  should  be  taken 
with  some  grains  of  allowance,  for  it  not  unfrequently 
happens  that  when  throat- affections  are  numerous, 
with  occasional  or  sporadic  cases  of  membranous  exu¬ 
dation,  all  wTill  be  grouped  together  under  the  head  of 
diptheria  ;  and  for  this  reason  it  is  exceedingly  diffi¬ 
cult,  in  many  cases,  to  judge  of  the  merits  or  demerits 
of  the  treatment  adopted.  Some  physicians  have 
claimed  unusual  skill,  or  a  superior  methodus  medendi , 
because  they  have  lost  less  than  ten  per  cent,  of  the 
cases  they  have  treated ;  but  it  is  not  certain  that,  had 
there  been  no  physician  in  the  case,  even  the  ten  per 
cent,  of  mortality  might  not  have  been  diminished. 

Professor  Alonzo  Clark,  in  his  recent  lectures  on 
diptheria,  in  relation  to  its  mortality,  remarks  : 

“We  now  turn  to  the  mortality  of  diptheria.  This 
is  a  complex  problem.  Its  fatality  in  its  different  oc¬ 
currences  and  in  different  places  varies  more  than  that 
from  any  other  disease  I  can  name  to  you.  In  certain 
families,  schools,  and  villages,  the  deaths  among  those 
attacked  are  more  numerous  than  from  any  other  epi¬ 
demic  affection.  The  proportion  is  not  less  than  that 
Horn  membranous  croup  or  tuberculous  meningitis. 


110 


Diptheria. 


Under  other  circumstances,  no  more  than  one  case  in 
forty  or  fifty  proves  fatal.  But  this  remarkable  differ¬ 
ence,  while  there  is  really  the  membranous  inflamma¬ 
tion,  is  less  embarrassing  than  the  fact  that  many  phy¬ 
sicians,  who  have  reported  their  observations,  have  not 
separated  their  cases  of  simple  tonsillar  inflammation 
without  any  pellicular  exudation,  from  those  of  true 
diptheria ;  but  on  the  contrary,  professing  to  regard 
the  two  affections  as  arising  from  the  same  cause,  since 
they  prevail  at  the  same  time,  have  grouped  them  to¬ 
gether,  and  so  have  greatly  reduced  their  proportion 
of  mortality.  I  have  already  said  that  there  is  but 
one  wray  of  treating  this  matter  fairly.  It  is  to  make 
the  membrane  the  basis  of  classification.  This  will 
separate  diptheria  from  everything  but  the  true  croup  ; 
and  the  marks  soon  to  be  indicated  will  commonly  be 
sufficient  to  establish  the  distinction  between  these. 
Indeed,  the  epidemic  character  of  one  and  the  sporadic 
occurrence  of  the  other  will,  of  itself,  be  enough,  at 
least  in  the  great  majority  of  instances.  It  may  be 
said  that  this  distinction  between  simple  and  dipthe- 
ritic  sore  throat  is  not  scientific.  It  may  be  so  ;  but  it 
is  better  than  scientific,  it  is  practical.  The  aim  and 
end  of  science  is  the  improvement  of  man’s  condition. 
If  this  improvement  can  be  but  attained  by  dividing 
into  two  groups  what  Nature  allows  us  to  class  as  one, 
no  rule  of  sound  reason  can  forbid  the  separation. 
Besides,  science  does  require  us  to  make  distinction? 
when  there  are  differences.  And  here  we  have  the 
broad  difference  that  one  disease  is  ephemeral,  with  a 
uniform  tendency  to  recovery  ;  the  other  is  often  terri¬ 
bly  fatal,  or  it  is  liable  to  a  long  train  of  sequences  of 
a  serious,  if  not  of  an  alarming  character. 

6i  An  example  will  enable  you  to  understand  how  far 


Mortality. 


Ill 


I  would  have  you  carry  the  distinction.  Five  children 
in  one  family  had  sore  throat,  all  occurring  within  the 
same  week.  The  same  cause  had  probably  operated 
on  all,  hut  the  effects  resulting  from  that  cause  were 
different  in  the  different  children,  and  the  difference, 
no  matter  how  produced,  was  cardinal  so  far  as  the 
safety  of  these  patients  was  concerned.  Three  of  them 
had  active  fever,  flushed  face,  pain  in  swallowing,  the 
tonsils  were  swollen  and  red,  and  on  the  anterior  and 
inner  surface  of  each  were  half  a  dozen  or  more  yel¬ 
lowish  white  spots.  The  matter  constituting  these 
spots  was  an  opaque  concretion  from  the  follicles  of 
these  organs,  and  each  mass  was  nearly  globular  in 
shape,  and  wTas  embedded  in  the  tonsil.  To  a  person 
not  familiar  with  their  appearance,  they  might  have 
been  mistaken  for  false  membrane ;  but  they  were 
rounded,  and  the  false  membrane  is  flat ;  they  were 
yellowish-white — the  membrane  is  very  rarely,  if  ever, 
of  this  color  ;  they  were  isolated — the  membrane  forms 
at  separate  points,  without  coalescing,  only  in  excep¬ 
tional  cases.  These  all  recovered  after  three  or  four 
days,  and  their  condition  excited  no  apprehension  for 
their  safety  so  long  as  the  diseased  action  went  no  fur¬ 
ther.  The  two  other  children  had  ash-colored  mem¬ 
branous  patches  on  the  tonsils.  In  one,  the  membrane 
did  not  extend  beyond  the  fauces,  and  although  it  fell 
off  and  formed  again,  the  sickness  was  not  very  grave, 
lasting  about  ten  days.  In  the  other  it  penetrated  into 
the  larynx  and  proved  fatal  in  three  days.  A  physi¬ 
cian’s  pride  is  in  his  cures,  yet  you  may  not  be  tempt¬ 
ed  to  say,  under  parallel  circumstances,  that  you  had 
five  cases  of  diptheria  and  lost  but  one  of  them. 
There  were  but  two  cases  of  diptheria.  A  physician 
reports  that  he  has  seen  two  hundred  cases  of  dipthe- 


112 


Diptheria. 


ria,  and  has  lost  only  three  or  four  per  cent.  Another 
physician  practicing  in  the  same  city,  in  the  same  epi¬ 
demic,  in  the  same  class  of  society,  and  adopting  the 
same  general  plan  of  treatment,  has  seen  a  hundred 
cases,  and  has  lost  thirty  per  cent.  The  latter  states 
that  he  only  counts  the  instances  of  membranous  dis¬ 
ease  ;  the  first  considers  his  cases  all  diptheria,  but 
does  not  say  that  membrane  is  his  test.  Would  you 
not  be  compelled  to  hesitate  before  you  admitted  these 
two  reports  into  the  same  generalization  ?  Physicians 
who  have  had  extraordinary  success,  should  tell  us  in 
so  many  words,  that  all  their  cases,  or  if  not  all,  how 
many,  exhibited  the  membrane.  You  will  not  find 
this  precision  when  you  wish  to  ascertain,  on  a  large 
scale,  the  law  of  mortality.  Thus  then  is  this  problem 
complicated.  But  we  must  do  the  best  we  can  with 
the  material  within  our  reach. 

“  From  the  £  Medical  History,  General  and  Particu¬ 
lar,  of  Epidemic,  Contagious,  and  Epizootic  Diseases 
in  Europe,  from  Demote  Times  to  our  own  Days,’  by 
Ozanam  (vol.  iii.-p.  279),  wTe  learn  that,  so  far  as  he 
could  ascertain  the  facts,  the  mortality  of  thirty-nine 
epidemics  of  what  is  now  regarded  as  diptheria,  be¬ 
tween  1559  and  1805,  was  as  high  as  eighty  in  the  hun¬ 
dred  of  those  attacked. '  The  Commission  of  the 
French  Academy  of  Medicine  (Martin  Solon,  and 
others)  reported  in  1833,  that,  in  the  French  epidemics 
from  1771  to  1830,  the  deaths  among  those  attacked 
by  croup  very  often  complicated  with  gangrenous  an¬ 
gina,  were  as  one  to  four  /  among  those  attacked  by 
angina,  membranous  and  gangrenous,  simple  or  com¬ 
plicated,  there  was  the  same  mortality,  that  is,  one  in 
four.  (£  Mem.  Acad.,’  vol.  iii.  p.  429.)  Trosseau 
found,  when  pursuing  his  inquiries  regarding  cutanc- 


Mortality. 


113 


oils  diptheria,  that  in  some  families  and  hamlets  fright¬ 
ful  havoc  had  been  made  by  the  throat  disease.  In 
one  family  seven  children  had  been  attached ,  and  six 
died.  In  one  hamlet  ten  in  twelve  had  died  ;  in  an¬ 
other  nineteen  in  twenty-one.  Dr.  Thayer  (. Berk's 
Medical  Journal )  states  that  Dr.  Beardsley  had  in 
Orange,  Conn.,  among  the  pupils  of  a  school,  and  in 
three  families  where  the  pupils  boarded,  fourteen  deaths 
in  fifteen  cases.  In  the  military  school  spoken  of  by 
Bretonneau,  and  referred  to  under  the  head  of  conta¬ 
gion,  four  deaths  had  occurred  in  as  many  cases,  when 
the  system  was  adopted  of  examining  the  throats  of 
all  the  pupils  daily  ;  by  this  means  sixty  cases  were 
seen  at  the  commencement  of  the  disease,  and  all  were 
successfully  treated  ;  the  mortality  was  thus,  including 
a  nurse  that  died,  one  in  thirteen.  Daviot  states  (‘  Me¬ 
morial  on  Diptheria,’  p.  363)  that  in  the  years  1841-2 
-3-4,  he  treated  four  hundred  and  sixty-one  cases,  and 
that  he  had  forty  deaths,  a  mortality  a  little  better 
than  one  in  eleven.  Dr.  Willard,  in  giving  a  history 
of  the  late  Albany  epidemic  (JY.  Y.  State  Med .  Soc. 
Trans .,  1859),  feels  authorized  to  reckon  the  cases  in 
that  city  at  two  thousand,  and  the  deaths  as  one  hun¬ 
dred  and  eighty-eight,  the  ratio  being  one  to  about  ten 
and  a  half.  Dr.  Iineeland  (Am.  Med.  Times ,  Jan.  26, 
1861)  living  in  the  central  portion  of  this  State,  ascer¬ 
tained  that  among  eighty  persons  attacked  in  his  neigh¬ 
borhood  ten  died,  or  one  in  eight.  Among  the  facts 
collected  by  Dr.  Thayer  are  the  following  :  six  cases 
in  Pittsfield,  Mass.,  and  three  deaths,  one  in  two  / 
twenty-four  cases  reported  by  Dr.  Bostwick,  of  Red 
Rock,  BT.  Y.,  and  five  deaths,  one  in  five  j  eighty-one 
by  Dr.  Meacham,  of  West  Stockb ridge,  Mass.,  and 
eight  deaths,  one  in  ten  nearly  /  one  hundred  and  thir- 


114 


Diptheuia. 


ty-six  by  Dr.  Wells,  of  Menomonee,  Wis.,  and  four 
deaths,  one  in  thirty -four  •  eighty -five  cases  by  Dr. 
Lawrence,  of  North  Adams,  Mass.,  and  no  death  / 
c  forty  or  fifty’  cases  by  Dr.  Holmes,  of  South  Adams, 
and  no  death.  Dr.  Jacobi,  of  this  city,  says  (Am. 
Med.  Times ,  Aug.  18,  1860),  £  Of  five  hundred  cases, 
we  believe  that  we  have  lost  not  more  than  thirty,’ 
about  one  death  in  seventeen  cases .  Dr.  Watson,  in  a 
paper  read  before  the  New  York  Academy  of  Medi¬ 
cine,  and  published  in  the  Am.  Med.  Times ,  states 
that  of  one  hundred  and  forty-eight  cases  treated  by 
himself,  only  two  proved  fatal,  one  in  seventy  four  / 
and  in  one  hundred  that  he  saw  in  the  practice  of 
other  physicians  of  the  city  only  four  died,  one  in 
twenty-five  /  in  all  together  about  one  in  forty-one. 
Dr.  Woodward,  of  Brandon,  Yt,  and  his  neighbor, 
Dr.  O’Dys  (Am.  Med.  Times ,  Dec.  5,  1860),  treated 
thirty  cases  each ,  without  a  single  death ,  and  Dr. 
Woodward  is  careful  to  state  that  his  cases  were  all 
true  diptheria.  In  an  adjoining  town,  where  the  dis¬ 
ease  occurred  before  it  reached  Brandon,  he  says  al¬ 
most  every  case  was  fatal.  Statements  that  vary  so 
widely  as  these  do  can  not  be  usefully  generalized. 
If  they  all  relate  to  the  same  type  of  disease,  they 
show  the  impossibility  of  applying  a  general  average 
to  particular  epidemics.  My  own  opportunities  of  see¬ 
ing  the  affection  force  upon  me  a  great  mortality  ;  but 
from  what  I  have  seen,  and  chiefly  from  wdiat  active 
practitioners  here  tell  me,  without  any  attempt  at  nu¬ 
merical  computation,  I  should  set  down  the  deaths  in 
New  York  among  those  having  the  membranous  dis¬ 
ease,  including  membranous  sore  throat  in  scarlet  fever, 
as  one  in  six  or  eight.  But  these  conjectural  estimates 
are  worth,  very  little.  Indeed,  accurate  statistics  will 


Mortality. 


115 


not  avail  much  in  informing  you  what  to  look  for  in 
any  commencing  or  expected  epidemic.  I  have  al¬ 
ready  told  you  this,  and  I  repeat  it  here  because  I  wish 
you  to  be  fully  aware  of  the  varying  types  of  the  dis¬ 
ease.  In  reviewing  what  has  just  been  said,  you  no¬ 
tice  that,  while  in  one  place  there  is  not  a  single  death 
among  sixty  persons  attacked,  by  what  the  writer  as¬ 
sures  us  is  true  diptheria,  in  an  adjoining  town  it  de¬ 
stroyed  nearly  all  whom  it  touched.  This  difference 
you  may  ascribe  to  different  plans  of  treatment.  I 
can  not  say  it  was  not  so  in  that  instance.  But  you 
will  hear  it  said  that  the  disease  is  very  grave  in  one 
place,  and  very  mild  in  another ;  that  the  earlier  cases 
in  a  school,  hospital,  or  town  are  attended  by  a  greater 
mortality  than  those  which  occur  later  in  the  epidemic. 
This  is  doubtless  true,  and  it  is  true  often  because  the 
type  of  the  disease  is  different  even  in  adjoining  towns, 
and  because  its  character  changes  as  the  epidemic  ad¬ 
vances.  I  am  told  by  a  leading  physician  of  Massa¬ 
chusetts,  that  in  a  town  within  the  range  of  his  consul¬ 
tation  practice,  nearly  every  case  is  fatal,  not  by  the 
direct  effects  of  the  membrane,  but  by  prostration  and 
collapse,  without  a  sign  of  dyspnoea  or  cyanosis  ;  while 
in  another  village  five  miles  distant  the  disease  has  the 
characters  of  an  open  inflammation,  from  which  the 
mortality  is  comparatively  inconsiderable,  and  when 
death  occurs  it  is  almost  always  caused  by  laryngeal 
and  tracheal  obstruction  through  the  extension  of  the 
membrane  from  the  fauces.  I  have  already  quoted 
statements  coming  from  two  pdiysicians  of  that  same 
county,  that  they  have  treated  one  hundred  and  twen¬ 
ty-five  cases  without  a  single  death,  both  saying  that 
the  disease  was  very  mild  (but  neither  of  them  saying 
that  it  was  characterized  by  a  membrane).55 


116 


Diptheeia. 


.  COMPLICATIONS.. 

Among  the  numerous  complications  which  are  said 
to  attend  diptheria,  authors  mention  sthenic  or  high 
fever ,  and  typhoid  or  low  fever.  I  must  dissent  from 
both  of  these  propositions.  The  truth  is  this.  The 
diathesis  of  the  disease  is  essentially  low  or  atonic,  and 
hence  can  never  have  high  or  sthenic  fever,  neither 
as  a  part  of  the  malady,  nor  as  an  accompaniment,  nor 
as  a  complication.  But  as  the  disease  is  essentially 
febrile,  and  of  low  diathesis,  and  of  continued  type,  it 
is  always  typhoid,  so  that  this  is  an  accompaniment 
and  not  a  complication.  The  error  of  medical  men 
consists  in  limiting  their  idea  of  fever  to  preternatural 
heat  of  the  surface,  and  in  mistaking  a  violent  disturb¬ 
ance  for  strength  of  action.  A  fever,  properly  so 
called,  consists  of  cold,  hot,  and  sweating  stages,  these 
together  constituting  the  paroxysm  ;  and  in  all  fevers 
excepting  the  ephemeral  type,  which  lasts  but  one  day, 
there  is  a  succession  of  paroxysms  ;  and  this  succession 
of  paroxysms  is  the  foundation  for  the  nosological 
arrangement  of  fevers  into  intermittent,  remittent,  and 
continued  types.  But  in  many  cases  of  low  fevers  the 
hot  stage  is  so  slight  as  to  be  scarcely  appreciable, 
and  the  careless  observer  may  regard  the  case  as  non- 
febrile.  When  the  heat  of  the  surface  is  more  consid¬ 
erable,  yet  slight  and  not  uniform,  the  term  u  feverish¬ 
ness”  is  generally  applied,  or  the  “  type”  of  the  fever  is 
said  to  be  typhoid.  And  when  the  whole  surface  is 
pretematurally  and  decidedly  hot,  the  fever  is  very 
apt  to  be  confounded  with  entonic  diathesis.  But,  as 
already  explained,  the  disease  is  always  febrile,  and 
the  fever,  as  wTell  as  the  local  inflammation,  is  always 
atonic  and  typhoid. 


Complications. 


117 


It  is  true  that  diptlieria  may  supervene  in  the  course 
of  a  simple  typhoid  fever ;  but  more  frequently  it 
happens  that  the  diptheritic  exudation  of  the  local 
inflammation  does  not  appear  until  the  constitutional 
symptoms  which  constitute  the  fever  have  been  man¬ 
ifested  for  one  or  two  weeks.  The  following  cases, 
mentioned  by  Dr.  Clark,  in  his  lectures  on  this  disease, 
are  in  point : 

“  Among  the  specimens  of  diptlieria  exhibited  to 
you  the  present  session,  you  will  remember  the  tonsils, 
uvula,  larynx,  trachea,  and  fine  divisions  of  the  bron¬ 
chial  tubes  of  an  adult  lined  by  false  membrane.  The 
patient  from  whom  the  specimen  was  taken  had  been 
suffering  from  typhoid  fever  for  two  weeks  at  the  Hew 
York  Hospital,  when  he  was  attacked  with  symptoms 
of  croup,  and  died  in  a  few  days,  tracheotomy  having 
been  unsuccessfully  performed.  Several  cases  of  a 
similar  character  were  seen  at  the  same  hospital  during 
the  epidemic  of  typhus  some  years  ago,  in  patients 
affected  by  that  disease.  It  seems  to  have  occurred  in 
these  cases  after  the  completion  of  the  second  week  of 
the  fever.  M.  Louis  (‘  Arch.  Gen.  de  Med.,’  tom.  iv., 
1824)  has  reported  two  cases  of  membranous  exudation 
in  the  air-passages,  and  the  usual  symptoms  of  dip- 
theria  in  patients  having  typhoid  fever.  One  was  a 
person  twenty-three  years  old,  who  had  been  fourteen 
days  in  the  hospital  before  the  symptoms  of  the  mem¬ 
branous  disease  began.  The  other  was  in  a  boy  aged 
fifteen  years.  Dr.  Greenhow  (‘On  Diptlieria  ?  p.  76) 
reports  that  Dr.  Heslop,  of  Birmingham,  found  in 
Hov.,  1858,  that  of  four  cases  of  typhus  fever  occur¬ 
ring  in  one  house,  two  of  the  patients  had  membranous 
exudation  in  the  throat.  In  one  of  these  it  is  stated 
that  the  patient,  a  girl  aged  seven  years,  had  suffered 


118 


Diptheria. 


nearly  a  fortnight  before  the  appearance  of  the  throat 
affection.  In  the  other  case  the  time  of  the  occurrence 
of  the  latter  is  not  mentioned.  M.  Louis’  cases  are 
described  under  the  title,  croup  in  adults ;  hut  as  dip¬ 
theria  was  prevailing  in  Paris  at  the  same  time,  it  is 
more  reasonable  to  refer  them  to  this  class.” 

Albuminaria  has  recently  attracted  the  attention  of 
physicians  as  a  complication  of  diptheria.  Says  Dr. 
Slade  :  “  An  element  in  the  nature  of  diptheria  is  of 
recent  discovery.  We  allude  to  the  presence  of  albu¬ 
minous  urine  in  the  disease.  The  first  observation 
upon  the  relation  of  albuminaria  to  diptheria  appears 
to  be  referable  to  a  case  reported  by  Mr.  Wade,  of 
Birmingham,  to  the  Queen’s  College  Medico-Chirur- 
gical  Society,  in  December,  1857,  and  afterward  pub¬ 
lished  in  his  c  Observations  on  Diptheria.’  Shortly  after 
this,  during  researches  on  this  disease  at  Paris,  M.M. 
Bouchut  and  Empis  made  a  similar  discovery.  Albu¬ 
minaria  did  not  exist  in  every  case  examined,  but  it 
was  seen  in  twelve  cases  out  of  fifteen.  Both  of  these 
authors  attach  great  importance  to  this  renal  compli¬ 
cation,  as  affording  an  anatomical  explanation  of  the 
cause  of  death,  when  this  can  not  be  attributed  to 
either  of  the  other  modes,  viz.,  death  by  asphyxia  or 
general  poisoning.” 

It  seems  to  me  that  albuminaria  can  hardly  be  “  an 
element  in  the  nature  of  diptheria”  unless  it  is  invari¬ 
ably  present ;  and  if  so  it  would  be  an  essential  part 
of  the  disease,  and  not,  in  any  sense,  an  accident  or 
complication  ;  nor  can  I  see  the  necessity  for  this 
“  anatomical  [pathological  ?]  explanation”  of  the  cause 
of  death,  when  the  patients  do  not  die  of  u  asphyxia  or 
general  poisoning,”  so  long  as  exhausted  vitality  is  a 
sufficient  cause  of  death  in  all  cases. 


Complications. 


119 


Other  authors,  however,  have  not  found  the  compli¬ 
cation  of  albuminous  urine  except  in  rare  instances, 
and  when  present,  they  do  not  regard  it  as  materially 
affecting  the  result.  Prof.  Clark,  whose  attention  was 
some  time  since  called  to  this  subject,  has  only  found 
albuminaria  as  an  occasional  accompaniment,  and  does 
not  regard  its  occurrence  as  in  any  manner  varying 
the  prognosis. 

Diarrhea ,  as  we  have  seen,  sometimes  precedes  and 
occasionally  accompanies  the  diptheritic  affection  of 
the  throat ;  and  in  some  instances  it  attends  the  later 
stages  of  the  malady,  when  it  is  regarded  as  an  accident 
or  complication.  It  is  always  a  serious  occurrence,  as 
it  indicates  great  exhaustion  of  the  vital  powers,  and, 
consequently,  danger. 

Vomiting  is  regarded  by  some  authors  as  a  diag¬ 
nostic  symptom,  and  by  others  as  an  incidental  occur¬ 
rence,  or  complication.  Though  less  dangerous  than 
diarrhea,  it  is  a  troublesome  and  grave  symptom. 

Swelling  of  the  glands  of  the  neck,  when  extreme,  is 
mentioned  by  Dr.  Clark  and  some  other  authors  as  a 
complication,  although,  in  a  majority  of  cases,  these 
glands  are  more  or  less  swollen  and  inflamed.  The 
chief  difficulty  arising  from  extreme  enlargement  of  the 
glands,  is  the  obstruction  it  occasions  to  respiration 
and  deglutition. 

“  Comaf  says  Dr.  Clark,  “  is  an  occasional  termina¬ 
tion  but  as  it  does  not  always  terminate  the  disease, 
nor  the  life  of  the  patient,  it  may  more  properly  be 
regarded  as  an  accident — a  complication.  It  is,  how¬ 
ever,  always  an  occurrence  of  dangerous  import. 


120 


Diptheria. 


SEQUELfE  OF  DIPTHERIA. 

Almost  all  of  tlie  eruptive  fevers,  and  more  especially 
measles,  scarlatina,  and  small-pox,  are  followed  by 
many  and  often  severe  after-symptoms  or  secondary 
diseases,  either  the  consequences  of  the  disease,  or  of 
the  treatment,  or  of  both.  And  in  this  respect  dip- 
theria  very  much  resembles  them.  Prominent  among 
these  sequelae,  authors  mention  various  forms  of  pa¬ 
ralysis,  otalgia,  amaurosis,  ophthalmia,  headache,  etc. 

“  After  apparent  recovery  from  the  immediate 
effects  of  the  disease, 57  says  Dr.  Slade,  “  in  many  cases, 
there  still  seems  to  be  lurking  in  the  system  the 
morbid  poison,  whose  special  affinity  is  for  the  nervous 
system.” 

Such  is  the  language  of  the  author  of  the  u  Fiske 
Fund  Prize  Essay,”  on  “  Diptheria ;  its  Nature  and 
Treatment.”  And  although  the  words  are  all  in  strict 
accordance  with  what  is  called  the  Medical  Science 
of  the  nineteenth  century,  yet,  judged  by  truly  sci¬ 
entific  principles,  they  are  utterly  nonsensical.  A 
“  morbid  poison”  implies  the  existence  of  a  normal 
poison.  But  Nature  teaches,  and  all  the  data  of  science, 
when  correctly  interpreted,  affirm,  that  no  poison  is 
wholesome  or  normal,  and  hence  no  poison  can  need 
the  qualification,  morbid.  Poison  is  poison,  and  that 
is  all  there  is  of  it.  Who  would  think  of  saying  “  black 
blackness,”  as  though  some  kinds  of  blackness  might 
be  white,  or  of  some  shade  between  ?  It  is  true  that 
there  are  white  blackberries,  and,  in  a  certain  stage  of 
development,  blackberries  may  be  said  to  be  green  when 
they  are  red;  but  poisons  do  not  undergo  organic 
transformations,  nor  do  they,  under  any  circumstances 


Sequelae.  121 

of  health,  or  disease,  change  their  relations  to  the  living 
system. 

But  more  absurd  even  than  the  notion  of  a  “  morbid 
poison,55  is  the  idea  that  it  has  a  “  special  affinity  foi 
the  nervous  system.55  It  seems  to  me,  that  if  medical 
authors  would  look  a  little  closer  to  the  definitions  of 
their  technical  words  and  phrases,  they  would  not  fill 
their  books  with  such  vague  and  meaningless,  not  to 
say  false  and  ridiculous  statements. 

The  only  relation  which  a  poison,  be  it  “  morbid55  or 
otherwise,  and  the  nervous  system  can  hold  to  each 
other,  is  that  of  repugnance  or  antagonism,  and  this  is 
exactly  the  opposite  of  affinity.  In  other  words, 
instead  of  the  poison  having  a  special  affinity  for  the 
nervous  system,  the  whole  living  organism  has  a  con¬ 
stitutional  antipathy  to  the  poison. 

“  The  most  frequent  form  of  paralysis,55  says  Dr. 
Slade,  “  has  been  that  of  the  soft  palate.  The  symp¬ 
toms  are,  a  nasal  twang  in  the  speech,  incapacity  for 
suction,  and  the  regurgitation  of  fluids  by  the  nostrils.55 

M.  Trosseau  states  that,  in  consequence  of  the  para¬ 
lytic  affection  being  more  local  than  general — in  other 
words,  the  palate  and  pharynx  being  more  usually 
affected  with  paralysis  than  the  system  generally — he 
was  for  a  long  time  under  the  impression  that  the  loss 
of  power  was  dependent  upon  the  inflammation  of  the 
coats  of  the  nerves  supplying  these  parts,  and  an 
infiltration  producing  pressure  on  their  motor  muscles. 
A  more  extensive  experience,  however,  of  the  general 
character  of  the  paralysis  which  accompanies  and 
follows  diptheritic  affections,  caused  him  to  change 
his  views,  and  he  now  believes  that  loss  of  power  and 
sensibility  is  the  direct  consequence  of  the  peculiar 
diptheritic  poison  acting  generally  on  the  system,  and 

6 


122 


Diptheria. 


strangely  modifying  the  blood.  M.  Trosseau  also 
states  that,  many  children  who  have  been  subjected  to 
the  operation  of  tracheotomy  fall  victims  to  paralysis 
of  the  epiglottis  and  larynx. 

Dr.  Faure  has  more  fully  described  the  debility  and 
paralysis  which  are  so  frequently  supposed  to  be  the 
sequelae  of  diptheria,  but  which  are,  I  fear  much  more 
frequently,  the  effects  of  the  drugs  which  are  admin¬ 
istered  for  the  cure  of  diptheria  : 

“  Some  time  after  an  attack  of  diptheria,  from 
which  the  patient  has  so  completely  recovered  that  no 
trace  of  false  membrane  is  left  behind,  the  skin  grows 
more  and  more  colorless  without  apparent  cause,  so 
that  at  length  it  assumes  almost  a  livid  pallor.  Severe 
pains  begin  at  the  same  time  to  be  felt  in  the  joints, 
the  patient  loses  power  over  his  limbs,  and  soon  sinks 
into  a  state  of  indescribable  weakness.  At  the  same 
time,  the  disorders  that  appear  in  different  functions 
show  that  the  various  organs  which  should  minister  to 
them  are  involved  so  far  as  they  are  dependent  upon 
muscular  power.  In  this  respect,  however,  the  phe¬ 
nomena  are  not  constant,  for  sometimes  it  is  one  set  of 
organs,  and  sometimes  another  which  suffers  most 
from  this  weakness.  Very  generally,  in  consequence 
of  the  want  of  muscular  power,  the  patient  becomes 
unable  to  sit  upright,  or  does  so  with  great  difficulty, 
while  the  legs  can  not  bear  the  weight  of  the  body  ;  all 
the  movements  grow  uncertain,  tottering,  hesitating, 
and  apparently  purposeless.  Very  remarkable  disor¬ 
ders.  show  themselves  also  within  the  throat,  for  the 
velum  is  completely  paralyzed,  and  hangs  down  like  a 
flaccid,  lifeless  curtain,  which  interferes  with  speech 
and  deglutition.  All  the  muscles  of  the  jaw,  neck, 
and  chest  are  partially  paralyzed,  in  consequence  of 


Sequelae. 


128 


which  mastication  is  rendered  difficult,  and  the  food 
can  be  neither  easily  moved  about  in  the  mouth  nor 
readily  swallowed.  Yision  is  impaired,  and  squinting 
is  not  unusual.  The  sensibility  of  the  skin  is  much  di¬ 
minished,  in  the  limbs  it  is  sometimes  completely  lost, 
though  morbid  sensations,  such,  for  instance,  as  formi¬ 
cation,  are  sometimes  experienced.  (Edema  of  the 
various  parts  often  occurs,  and  occasionally  parts  here 
and  there  lose  their  vitality  and  become  gangrenous. 
jSTo  general  reaction  occurs  ;  fever  is  rare.  The  fea¬ 
tures  grow  duller  and  more  and  more  expressionless, 
though  a  foolish  smile  sometimes  crosses  them,  or  now 
and  then  a  ray  of  intelligence  appears.  Some  patients 
have  frequent  fainting  fits.  As  the  condition  goes  on 
from  bad  to  worse,  the  weakness  becomes  extreme,  and 
death  at  length  follows  some  fainting  fit,  or  takes  place 
when  exhaustion  has  reached  its  uttermost ;  life,  as  it 
were,  quietly,  almost  imperceptibly,  passing  away.” 

Dr.  Greenhow  remarks  :  “  Under  the  most  favorable 
circumstances,  persons  who  have  suffered  from  fully 
developed  diptheria  often  remain  feeble,  ailing,  and 
anaemic  for  many  weeks  ;  and  the  throat  sometimes 
continues  to  present  traces  of  the  disease  long  after¬ 
ward,  or  is  very  susceptible  to  the  influence  of  cold  or 
raw  weather.  Occasionally,  many  months  elapse  be¬ 
fore  perfect  recovery ;  and  I  have  known  one  instance 
in  which  the  patient  did  not  regain  his  strength  for 
nearly  a  year.  Besides  the  extreme  anaemic  which  is 
so  marked  a  result  of  diptheria,  this  disease  is  very  apt 
to  be  followed  by  certain  nervous  affections  of  a  pe¬ 
culiar  kind.  These  consist  of  paralysis  and  anesthe¬ 
sia  of  particular  muscles,  tenderness  and  tingling  of 
the  skin,  gastrodynia,  impairment  of  vision,  and  deaf¬ 
ness. 


124: 


Diptheria. 


“  Few  persons  recover  without  impaired  voice  or 
power  of  deglutition,  arising  from  paralysis  of  the 
muscles  of  the  throat ;  and  sometimes,  though  rarely, 
there  is  complete  aphonia,  or  absolute  inability  to 
swallow.  The  husky,  nasal  voice  which  follows  dip- 
theria  is  very  striking,  and  closely  analogous  in  char¬ 
acter  to  that  of  persons  suffering  from  syphilitic  affec¬ 
tion  of  the  throat.  It  is  remarkable  that  this  affection, 
in  common  with  the  other  nervous  sequelae  not  yet  de¬ 
scribed,  very  often  does  not  manifest  itself  until  the 
patient  is  in  other  respects  convalescent.  The  impaired 
power  of  deglutition  consists  sometimes  of  a  difficulty 
in  swallowing  liquids,  sometimes  solids  ;  but  the  for¬ 
mer  is  the  more  common.  Patients  are  sometimes 
able  to  eat  a  hearty  meal  without  difficulty,  but  when 
they  attempt  to  drink,  a  large  portion  of  the  liquid  is 
regurgitated  through  the  nostrils. 

“  The  difficulty  in  swallowing  liquids,  and  the  nasal 
tone  of  the  voice,  are  usually  found  in  the  same  person ; 
and  although  the  voice  is  sometimes  slightly  affected 
without  impaired  power  of  deglutition,  the  latter  is 
very  rare  without  the  former.  Difficulty  in  swallow¬ 
ing  solids,  when  the  power  of  swallowing  liquids  is 
comparatively  perfect,  occurs  but  seldom. 

u  Paralysis  of  the  muscles  of  the  neck,  producing 
inability  to  carry  the  head  erect,  is  an  occasional,  but 
rare,  sequel  of  the  disease.  Among  a  great  many  con¬ 
valescents  from  diptheria  that  I  have  seen,  not  one  has 
suffered  from  this  affection.” 

The  following  case — interesting  chiefly  because  of 
the  time  that  elapsed  between  the  affection  of  the 
throat  and  the  development  of  the  secondary  disease 
— has  been  pub  ished  by  Dr.  Gull,  in  the  London  lan¬ 
cet  : 


Sequels. 


125 


“  A  bo y,  eleven  years  of  age,  bad  an  affection  of  the 
throat  from  which  he  convalesced,  and  was  sent  into 
the  country  for  change  of  air.  About  five  weeks  from 
the  time  of  his  being  taken  ill,  it  was  noticed  that  he 
did  not  carry  the  head  erect — it  drooped  to  one  side  or 
the  other.  There  was  an  occasional  difficulty  in  deglu¬ 
tition,  loss  of  voice,  and  attacks  of  dyspnoea,  threaten¬ 
ing  asphyxia.  In  a  day  or  two  from  the  beginning  of 
these  symptoms,  the  breathing  became  entirely  tho¬ 
racic.  The  diaphragm  was  unmoved  in  inspiration 
and  depressed  in  expiration,  indicating  a  loss  of  power 
in  the  phrenic  nerves.  Deglutition  was  next  to  impos¬ 
sible.  The  child  could  utter  no  sound.  There  were 
fearful  attacks  of  strangulation  when  the  head  was 
moved  in  particular  positions,  and  even  when  the 
breathing  was  at  the  best,  there  were  blueness  of  the 
lips  and  tracheal  rales.  The  intelligence  remained  un¬ 
affected.  The  legs  could  be  moved  only  feebly  ;  the 
movement  of  the  arms  was  not  impaired  ;  the  muscles 
of  the  neck  were  wasted  and  flaccid ;  there  was  no 
swelling  of  the  fauces;  over  the  transverse  processes 
of  the  cervical  vertebrae,  on  the  right  side,  there  was 
tenderness,  and  the  adjacent  deep-seated  absorbent 
glands  were  slightly  enlarged ;  no  febrile  excitement. 
Pulse  feeble,  90.  A  paroxysm  of  suffocation  suddenly 
terminated  the  life  of  the  patient.” 

A  singular  paralysis  of  the  muscles  of  the  neck,  oc¬ 
curring  after  diptheria,  is  reported  by  Mr.  Grundy,  of 
Newick,  in  the  case  of  his  own  son.  The  head  rolled 
about  by  its  own  weight  backward,  forward,  and  side- 
wise,  exciting  fear  of  dislocation ;  and  when  it  settled, 
the  child  was  apparently  unable  to  move  it,  and  looked 
about  him  with  a  curiously  slow  turning  of  the  eye¬ 
ball. 


126 


Diptheria. 


“  Paraplegia,”  says  Dr.  Greenhow,  “  is  by  no 
means  an  uncommon  sequel  of  diptheria,  and,  though 
more  rarely,  paralysis  of  the  arms.  Sometimes  the 
paralytic  affection  is  of  a  hemiplegic  character.  The 
following  case,  which  I  had  the  opportunity  of  seeing 
with  Dr.  Morris,  of  Spalding,  illustrates  several  of  the 
points  just  mentioned,  though  the  paralysis  was  less 
complete  than  in  some  other  cases  which  I  have  seen  : 
P.  A.,  twenty- eight  years  of  age,  resides  in  a  small 
but  clean  and  wholesome  house  at  Pinchbeck.  His 
case  was  the  worst  that  Dr.  Morris  had  ever  seen  to  re¬ 
cover.  On  Friday,  January  28th,  1859,  he  felt  a 
£  nasty  taste5  in  the  mouth.  On  the  following  day  he 
complained  of  sore  throat,  and  on  examination  by  Dr. 
Morris  it  was  found  to  be  congested  and  inflamed. 
On  the  30th,  the  tonsils,  soft  palate,  and  posterior  fau¬ 
ces  were  covered  with  false  membrane,  and  the  case 
subsequently  became  one  of  malignant  diptheria. 
March  20 :  patient  very  pallid  and  ansemic ;  voice 
thick,  snuffling,  and  nasal ;  there  is  a  white  filmy  patch 
on  either  side  of  the  arch  of  the  palate,  that  on  the 
right  side  being  the  largest ;  the  uvula  has  nearly 
sloughed  away,  and  he  says  that  at  the  time  of  its  oc¬ 
currence  the  stench  was  so  bad  that  he  could  scarcely 
bear  it.  On  the  right  of  the  posterior  fauces  is  a  patch 
of  opaque  white  false  membrane,  the  size  of  a  split 
pea ;  the  rest  of  the  posterior  fauces  is  covered  with  a 
semi-transparent  secretion.  Skin  sweaty ;  pulse  72, 
feeble.  Sight  a  little  dim  ;  complains  of  numbness  in 
the  belly,  and  in  the  legs,  arms,  and  hands,  but  espe¬ 
cially  in  the  left  arm  and  leg.  Is  unable  to  dress  him¬ 
self,  from  weakness  of  the  arms ;  has  lately  felt  prick¬ 
ing  as  of  pins  and  needles  in  the  fingers ;  is  rather 
giddy  when  out  of  doors,  and  still  has  slight  difficulty 


Sequelae. 


127 


in  swallowing.  Three  weeks  since,  his  face  was  puffed 
in  the  morning,  and  there  was  slight  edema  of  the 
feet  and  legs,  particularly  at  night ;  urine  pale  colored, 
clear,  and  free  from  albumen.” 

It  is  to  be  regretted  that,  in  the  reports  of  these 
cases,  no  allusion  whatever  is  made,  except  in  rare 
cases,  to  the  treatment.  Says  Dr.  Bigelow,  of  Boston, 
in  a  late  work  (u  Nature  in  Disease”) :  “  The  effect  of 
remedies  is  so  mixed  up  with  the  phenomena  of  dis¬ 
ease,  that  the  mind  lias  difficulty  in  separating  them.” 

I  apprehend  that  the  truth  of  this  remark  is  quite  as 
applicable  to  diptheria  and  its  sequelae,  as  to  all  other 
forms  of  disease.  The  ordinary  drug-medication  of 
diptheria  is  enough  in  many  cases  to  paralyze  not  only 
the  muscles  of  the  neck,  but  those  of  the  whole  sys¬ 
tem,  as  is  partially  illustrated  in  the  following  case 
related  by  Greenhow,  in  which  we  have  a  hint  of  some 
of  the  remedial  measures  employed  :  “  A  woman,  hav¬ 
ing  been  recently  confined,  contracted  diptheria  from 
a  patient  in  a  neighboring  bed.  Alum  in  suffiations 
and  applications  of  hydro  chloric  acid  were  resorted  to, 
with  the  effect  of  removing  all  diptheritic  exudation. 
On  the  tenth  day  she  spoke  with  a  nasal  voice,  and 
deglutition  was  very  difficult,  and  accompanied  with 
nasal  regurgitation.  A  notable  proportion  of  albumen 
was  also  found  in  the  urine.  The  paralytic  affection 
of  the  pharynx  kept  increasing,  so  that  by  the  twenty- 
fifth  or  thirtieth  day  the  woman  could  no  longer  swal¬ 
low,  and  was  like  to  have  died  while  trying  to  take 
some  solids.  About  the  fortieth  day  some  improve¬ 
ment  in  this  respect  took  place,  but  some  numbness  of 
the  hands  and  feet  was  observed,  as  well  as  defective 
pronunciation  from  imperfect  movement  of  the  tongue. 
By  the  fiftieth  day,  progression  had  become  uncertain, 


128 


Diptheeia. 


and  general  nervous  symptoms,  chiefly  consisting  in 
delirium  and  convulsions,  set  in.  The  worst  apprehen¬ 
sions  were  now  entertained  ;  but  musk  having  been 
administered,  some  improvement  took  place.  So  con¬ 
siderable,  however,  was  the  paralysis,  that  the  patient 
could  not  raise  herself  without  the  assistance  of  two 
nurses.  The  bladder  was  also  affected  during  two  or 
three  days,  but  not  the  rectum.  With  this  paralytic 
condition  anaesthesia  coexisted,  the  patient  remaining 
absolutely  insensible  to  pricking  with  needles.  On  the 
hundred  and  fiftieth  day  the  symptoms  were  so  much 
ameliorated  under  the  use  of  the  syrup  of  the  sulphate 
of  strychnia ,  that  the  patient  could  get  in  and  out  of 
bed  easily,  could  knit  a  little,  and  was  able  to  distin¬ 
guish  between  wool  and  cotton  by  the  touch.  No  dis¬ 
turbance  of  visual  power  took  place,  although  during 
six  weeks  enormous  quantities  of  albumen  were  found 
in  the  urine.” 

The  medication  in  the  above  case,  though  far  from 
being  as  potent  as  is  frequently  prescribed,  is  amply 
sufficient,  in  my  judgment,  to  account  for  all  the  com¬ 
plications  and  sequelae  which  afflicted  the  unfortunate 
woman,  and  for  the  protracted  convalescence.  All  of 
the  caustic  and  burning,  pungent,  local  applications, 
including  nitrate  of  silver,  chlorate  of  potassa,  alcohol, 
etc.,  are  of  paralyzing  tendency,  and  any  variety  or 
quantity ,  if  I  may  be  allowed  the  expression,  of  “  gen¬ 
eral  nervous  symptoms,”  may  be  justly  attributed  to 
their  employment ;  and  when  the  effects  of  these  rem¬ 
edies  become  “  mixed  up”  with  the  phenomena  of  dis¬ 
ease,  I  know  of  no  way  in  which  the  physician  can 
separate  them. 

Because  the  patient,  after  lingering  one  hundred  and 
forty-nine  days,  in  virtue  of  an  enduring  constitution, 


Sequelae. 


129 


improved  while  taking  the  deadly  dogbane,  or  because 
her  symptoms  became  ameliorated  while  “  under  the 
use ”  of  this  drag,  it  by  no  means  follows  that  the 
strychnine  contributed  to  the  amelioration  of  the  symp¬ 
toms.  On  the  contrary,  any  one  who  can  reason  from 
the  physiological  instead  of  the  pathological  stand-point 
— who  can  interpret  the  effects  of  remedies  and  the 
phenomena  of  disease  by  the  unerring  standard  of  the 
laws  of  Nature  as  manifested  in  and  through  the  vital 
organism,  instead  of  by  the  false  and  absurd  dogmas 
of  medical  schools,  as  taught  in  their  books  on  materia 
medica — will  know  absolutely  that  all  such  patients, 
when  they  improve  or  recover,  do  so  in  spite  of  the 
medicine.  No  person  whose  brain  is  not  prepossessed 
and  prejudiced  by  the  false  theories  of  the  day  which 
pass  current  in  the  world  as  medical  science,  can  read 
the  “  modus  operajidi ”  of  strychnine,  as  stated  in  any 
of  the  standard  works  on  materia  medica,  and  not 
come  to  the  conclusion  that  its  effects  are  in  every  case, 
and  stage,  and  condition  of  diptheria,  as  well  as  in  all 
of  its  complications,  incidents,  accidents,  accompani¬ 
ments,  concomitants,  or  sequelae  (and  the  same  is 
equally  true  of  all  other  diseases),  to  prolong  the  pa¬ 
tient’s  sufferings,  lessen  his  chance  of  final  recovery, 
and  render  recovery  less  complete. 

“  Impaired  vision ,”  says  Dr.  Greenhow,  “  is  another 
common  sequel  of  diptheria,  which,  like  those  already 
described,  only  comes  on  subsequently  to  recovery 
from  the  primary  local  disorder.  The  patient  is  usu¬ 
ally  able  to  see  distant  objects  with  sufficient  distinct¬ 
ness,  but  is  unable  to  see  things  close  at  hand.  In¬ 
deed,  several  of  the  most  striking  cases  that  have  come 
under  my  notice  were  those  of  children  who  appeared  to 
be  quite  well  until,  on  returning  to  their  studies,  it  was 

6* 


130 


Diptheeia. 


found  that  they  could  not  see  to  read.  The  defective 
vision  comes  on  gradually ;  first  of  all,  the  patient  is 
unable  to  read  small  print,  and  can  only  read  large 
print  when  held  at  a  distance  from  the  eye,  a  power 
which  is  also  lost  at  a  later  period.  The  restoration  of 
sight  is  equally  gradual.” 

As  I  have  never  noticed  any  serious  difficulty  of 
vision  as  a  sequel  of  diptheria,  in  cases  where  the  pa¬ 
tient  has  been  treated  hygienically,  and  as  quinine  and 
other  similar  drugs  are  well  known,  when  given  in 
large  doses,  to  affect  the  vision  very  seriously,  I  am  ap¬ 
prehensive  that  this  “  sequel”  of  impaired  vision  has 
some  definite  relation  to  the  medication.  Many  prac¬ 
titioners  recommend  the  free  use  of  quinine  and  other 
“  supporting”  agents  throughout  the  whole  course  of 
the  disease.  Indeed,  the  plan  of  treating  typhoid  and 
other  low  fevers  with  brandy  and  .quinine,  from  the 
commencement  of  the  disease  to  the  end  of  the  con¬ 
valescence,  on  the  senseless  vagary  of  “  keeping  the 
patient  up”  while  the  disease  runs  its  course,  or  on 
the  equally  chimerical  fantasy  of  a  carrying  the  patient 
through  the  disease,”  has  recently  been  revived  by 
Dr.  Todd,  of  England,  and  some  other  practitioners, 
so  that  we  may  soon  look  for  impaired  vision — and 
also  for  deafness ,  which  is  a  very  common  effect  of 
quinine — among  the  very  common  sequelae  of  an  ex¬ 
tensive  range  of  febrile  maladies. 

As  an  illustration  of  some  of  the  nervous  sequelae , 
the  case  of  Dr.  Moyce,  of  Rotherfield,  Eng.,  is  related  : 
“  On  ETov.  8,  1858,  he  felt  a  sensation  of  pricking, 
which  soon  became  burning,  in  the  right  tonsil.  In 
the  night  there  was  much  pain,  with  a  sense  of  swell¬ 
ing.  The  next  morning  there  was  on  the  right  tonsil 
a  patch  of  exudation  about  the  size  of  a  farthing, 


Sequels. 


131 


which  gradually  extended  forward  almost  to  the  teeth  ; 
the  left  side  was  very  slightly  affected.  There  was 
much  external  swelling.  After  four  or  five  days  the 
exudation  began  to  clear  away,  and  then  pain  and 
difficulty  in  swallowing,  amounting  to  agony,  super¬ 
vened.  In  the  course  of  three  or  four  weeks  he  got 
about,  and  attended  to  his  practice  for  a  fortnight. 
During  the  latter  half  of  December  the  tone  of  his 
voice  became  altered,  and  he  began  to  have  regurgita¬ 
tion  of  solid  food,  which  would  accumulate  in  the  pos¬ 
terior  nares  until  it  caused  spasmodic  cough.  He  was 
able  to  swallow  fluids,  if  taken  very  slowly.  He  now 
lost  the  use  of  his  tongue,  could  not  move  it  in  eating, 
and  his  speech  became  unintelligible ;  he  also  began 
to  see  double,  and  indistinctly,  but  could  see  with  spec¬ 
tacles.  Hext  followed  tingling  and  tenderness  of  the 
palmar  surface  of  the  hands  and  fingers,  accompanied 
with  a  peculiar  hardness  and  roughness  of  the  integu¬ 
ments.  Presently  the  soles  of  the  feet  and  toes  were 
similarly  affected,  and  then  there  was  loss  of  power  in 
the  limbs,  especially  the  legs.  The  arms  were  so  weak 
that  he  was  unable  to  feed  himself.  The  symptoms  re¬ 
mained  unabated  for  eight  or  nine  weeks,  and  then 
gradually  diminished  in  the  same  order  in  which  they 
had  begun.  Even  now,  after  a  lapse  of  two  years  and 
a  half,  he  is  not  strong,  and  can  neither  walk  nor  swal¬ 
low  so  well  as  before  his  illness.” 

It  is  deeply  to  be  regretted  that  in  so  extraordinary 
a  case  affecting  a  medical  man,  not  a  word  nor  a  hint 
should  be  given  in  relation  to  the  treatment.  If  the 
Doctor  dosed  himself  with  calomel,  quinine,  stimu¬ 
lants,  and  tonics,  alteratives  and  antiseptics,  continu¬ 
ally,  the  “  nervous  sequelae”  and  the  prolonged  conva¬ 
lescence  may  be  easily  accounted  for. 


132 


Diptheria. 


The  following  case,  related  by  Dr.  Gull,  is  suggestive 
of  mercurialization ,  though  not  a  word  is  said  as  to 
the  treatment : 

“  A  boy,  of  rather  delicate  temperament,  when  re¬ 
covering  from  diptheria,  was  suddenly  seized  with  in¬ 
tense  neuralgia  in  the  left  leg,  which  passed  off  after  a 
day.  It  appeared  to  be  connected  with  the  femoral  vein, 
which  wTas  rather  hard  and  very  painful  to  the  touch. 
After  two  days  he  became  very  restless,  and,  in  a  few 
hours,  completely  hemiplegic  on  the  right  side,  includ¬ 
ing  the  face,  and  speechless.  The  action  of  the  heart 
was  most  tumultuous,  and  the  sounds  muffled.  The 
child  rallied  under  the  free  use  of  wine  and  ammonia ; 
but  the  hemiplegia  remained  for  many  months,  after 
which  there  was  slow  improvement.55 

This  “  rallying55  under  the  use  of  stimulants  is  one 
of  the  great  delusions  of  the  medical  profession,  and 
of  the  non-professional  people.  The  effect  or  disturb¬ 
ance  which  is  called  “  rallying,55  or  “  reaction,55  is  the 
resistance  of  the  living  system  to  the  poisons.  It  is  the 
drug  fever  ;  nor  is  it  any  the  less  injurious  to  the  pa¬ 
tient  because  it  is  termed  stimulation ,  and  is  caused  by 
a  drug  which  is  termed  medicine ,  than  it  is  when  it  is 
called  disease  or  fever,  and  is  caused  by  a  drug  which 
is  called  a  “  morbid  poison.55 

Says  Dr.  Greenhow  :  “  The  majority  of  cases  which 
are  protracted  until  the  development  of  the  nervous 
sequelge,  recover,  but  death  occasionally  takes  place 
even  at  a  remote  period.  Dr.  Moyce  mentions  the 
death  of  a  boy,  aged  eleven  or  twelve  years,  from  ex¬ 
haustion  during  the  paralytic  stage,  two  months  after 
he  had  been  quite  free  from  throat  affection.55 

In  view  of  the  ordinary  treatment  of  diptheria,  I 
think  the  above  remarks  should  be  understood  as 


Sequelae. 


133 


meaning,  if  the  patient  can  survive  both  the  disease 
and  the  remedies,  he  may  recover  sooner  or  later,  al¬ 
though  he  may  long  suffer  from  the  chronic  disease 
induced  by  the  medication. 

And  still  more  to  the  point  says  the  same  author : 
“  The  nervous  sequelae  of  diptheria  are  not  always  in 
proportion  to  the  severity  of  the  previous  illness,  and 
do  not  occur  exclusively  after  the  severest  cases,  but 
sometimes  follow  comparatively  mild  attacks.  Their 
duration  is  uncertain,  varying  from  two  to  three  or 
four  months,  but  the  slighter  affections  may  perhaps 
sometimes  pass  off  in  a  shorter  period  than  two 
months,  and,  in  all  probability,  severe  cases  are  occa¬ 
sionally  prolonged  beyond  the  fourth  month. 55 

If  the  sequelae  were  legitimately  the  consequences 
of  the  diptheria,  or  of  the  causes  of  diptheria,  it  would 
logically  and  necessarily  follow  that  the  more  severe 
the  disease  the  greater  the  liability  to  sequelae,  and  the 
more  severe  the  sequelae.  But  if  the  sequelae  are 
chiefly  attributable  to  the  remedies  employed  for  the 
cure  of  the  diptheria,  then  we  may  properly  expect 
just  what  our  authors  inform  us  is  the  fact,  that  mild 
cases  of  the  disease  may  be  attended  with  dangerous 
complications,  or  followed  by  severe  sequelae,  and  vice 
versa. 

Bronchitis  and  Pneumonia  are  named  by  some 
authors  as  complications,  and  by  other  authors  as  se¬ 
quelae  of  diptheria.  But  I  think  the  bronchial  af¬ 
fection  is  merely  the  extension  of  the  diptheritic  exu¬ 
dation  to  the  bronchial  tubes  ;  and  that  the  pneumonia 
is  the  same  with  a  more  considerable  degree  of  con¬ 
gestion  in  the  lungs— a  condition  which  may  occur  in 
the  dying  struggle.  And  these  views  are  corroborated 
by  all  the  circumstances  of  the  cases  adduced  to 


134 


Diptheria. 


prove  the  existence  of  these  affections.  Mr.  Thompson 
reports  the  following  case,  in  the  British  Medical  Jour¬ 
nal  for  June  5,  1858  :  “  A  gentleman,  aged  forty-six, 
died  from-  this  condition  of  the  lungs.  His  throat  was 
first  affected.  After  a  few  days  the  breathing  became 
impeded,  with  all  the  ordinary  symptoms  of  capillary 
bronchitis  in  the  first  stage,  the  throat  continuing  to 
improve.  He  gradually  sank,  constantly  expectorating 
casts  of  the  small  tubes,  precisely  similar  to  the  de¬ 
posits  in  the  trachea.” 

Drs.  Greenhow,  Bristowe,  and  others,  state  that 
they  have  only  found  the  occurrence  of  pneumonia  as 
a  complication  of  diptheria  has  only  come  under  their 
observation  in  post-mortem  examinations.  Mr.  Hush, 
of  Southampton,  mentions  two  cases  in  which  fatal 
pneumonia  supervened  after  the  exudation  had  disap¬ 
peared  from  the  throat,  and  the  patients  were  supposed 
to  be  doing  well. 

The  occurrence  of  fatal  secondary  diseases,  long 
after  convalescence  in  relation  to  the  primary  disease 
has  been  established,  is  always,  to  my  mind,  suggestive 
of  drug-disease.  And  does  not  Professor  Paine,  in  his 
“  great  work”  (u  Institutes  of  Medicine”),  declare,  as  the 
basis  and  rationale  of  the  wdiole  drug  system  of  med¬ 
ical  practice,  “  we  do  but  cure  one  disease  by  produc* 
ing  another.”* 


MORBID  ANATOMY  OF  DIPTHERIA. 

Post-mortem  examinations  can  never  reveal  the  es¬ 
sential  nature  nor  the  causes  of  any  disease  ;  they  can 
only  exhibit  the  effects  of  disease — the  morbid  condi¬ 
tions  which  occur  in  its  progress,  and  the  structural 
derangements  which  take  place  after  death.  But  these 


Morbid  Anatomy. 


185 


effects  and  derangements  may  be  the  results  of  the  dis¬ 
ease  itself,  or  of  the  medication,  or  of  both.  And  if  it 
is  very  difficult  to  discriminate  between  the  phenome¬ 
na  of  disease  and  the  effects  of  remedies  in  the  living 
subject,  it  is  still  more  difficult  to  determine,  in  the  ca¬ 
daver,  wffiat  appearances  are  due  to  the  original  dis¬ 
ease,  or  to  its  causes,  or  to  the  medicines,  which  are 
themselves  morbific  agents,  and  must  of  necessity  in¬ 
duce  disease.  Hundreds  of  post-mortem  examinations 
have  been  made  after  deaths  of  pneumonia — ■inflamma¬ 
tion  of  the  lungs ;  and  when  mercurial  and  antimo- 
nial  remedies  had  been  prescribed,  there  have  been 
found  as  complications  and  sequelae,  morbid  conditions 
of  the  stomach  and  bowels  to  which  the  terms  gastritis 
and  enteritis  are  applicable.  Whence  this  inflamma¬ 
tion  of  the  stomach  and  bowels  ?  Dr.  Ames,  of  Mont¬ 
gomery,  Alabama,  in  an  article  published  in  the  Mew 
Orleans  Medical  and  Surgical  Journal ,  a  few  years 
ago,  states  that  these  complications  are  found  only  in 
cases  which  have  been  treated  with  bleeding,  calomel, 
tartar  emetic,  and  other  powerful  drugs — never  in 
cases  treated  with  what  are  called  simple  remedies  or 
mild  medicines. 

What  do  these  facts  prove  ?  What  can  they  prove, 
except  the  admitted  fact  that  all  drug-medicines  are 
poisons,  that  all  poisons  induce  diseases,  and  that  when 
poisons  are  administered  as  remedies  to  cure  diseases, 
we  must  of  necessity  find  the  effects  of  remedies  and 
the  phenomena  of  disease  so  u  mixed  up7’ — to  quote 
again  the  language  of  Dr.  Bigelow — as  to  render  it 
exceedingly  difficult  to  distinguish  the  one  from  the 
other. 

In  estimating  the  value  of  pathological  anatomy,  we 
must  ever  keep  in  mind  that  the  dead  structures  can 


136 


Diptheria. 


only  disclose  tlie  effects  of  morbific  agents  and  pro- 
cesses ;  they  can  never  explain  the  remedial  actions — 
the  vital  struggle — which  constitutes  the  very  essence 
of  disease.  My  work  would  be  incomplete  without  a 
chapter  on  this  subject;  and  as  Dr.  G-reenhow  has  pre- 
sen  ted  in  his  late  work  all  of  the  facts  pertaining  to 
the  morbid  anatomy  of  diptheria  which  are  known  to 
the  profession,  or  which  can  be  of  use  in  determining 
either  the  nature,  the  causes,  or  the  proper  treatment 
of  the  disease,  with  illustrative  cases,  I  copy  his  en¬ 
tire  article,  premising  that  a  careful  examination  of 
all  evidences  can  hardly  fail  to  convince  the  candid 
reader,  especially  if  he  is  familiar  with  the  effects  of 
medicines  as  explained  in  the  works  on  materia  medica 
and  therapeutics,  that  many  of  the  morbid  appearances 
described  are  quite  as  likely  to  be  the  effects  of  drug- 
poisons  as  of  diptheria  or  its  causes. 

“  Diptheria  is  essentially  an  inflammation  of  the 
fauces,  which  sometimes  only  causes  disordered  secre¬ 
tion  from  the  mucous  membrane ;  at  others,  produces 
ulceration,  and  even  gangrene  ;  but,  more  frequently, 
an  exudation  which,  coagulating  on  the  surface,  forms 
the  false  membrane  from  which  the  disease  obtains  its 
name.  The  exudation  varies  in  consistency  from  a 
pultaceous  or  almost  liquid  exudation  to  a  firm,  con¬ 
sistent,  and  more  or  less  elastic  membrane.  In  the 
latter  case,  its  outer  surface  is  often  uneven,  usually 
less  dense  than  the  deeper  portion,  and  sometimes  floc- 
culent  or  fissured.  It  varies  from  a  quarter  of  a  line 
to  a  line  or  more,  and,  in  one  instance  I  have  seen,  was 
nearly  two  lines  in  thickness.  The  elastic  form  of  false 
membrane  is  not  unlike  the  exudation  poured  out  from 
an  inflamed  serous  membrane.  Sometimes  the  exuda¬ 
tion  is  not  membranous,  but  dry  and  granular. 


Morbid  Anatomy. 


137 


“  Low  forms  of  cryptogamic  plants  are  occasionally 
found  on  the  exudation,  a  circumstance  which  gave 
rise  to  the  belief  that  the  disease  is  of  parasitic  origin. 
This  opinion  is  disproved  by  the  facts  that,  on  the  one 
hand,  the  supposed  parasite  is  not  invariably  present 
in  diptheria;  and,  on  the  other,  that  it  is  frequently 
found  on  unhealthy  mucous  surfaces  which  are  not  of 
a  diptheritic  nature.  Examined  under  the  microscope, 
the  exudation  is  found  to  consist  of  coagulated  fibrine 
and  epithelium,  the  latter  being  usually  more  abundant 
in  the  outer  portion,  or  layer  of  membrane ;  while  the 
deeper  portion  is  more  purely  fibrinous.  But  in  this 
respect  there  are  numerous  variations.  Exudation  cells 
are  often  intermixed  with  the  fibrillated  texture.  The 
exudation  is  sometimes  already  undergoing  decomposi¬ 
tion,  or  other  change,  before  it  leaves  the  throat,  and 
is  at  others  more  or  less  stained  with  blood.  At  first 
only  opaque,  the  exudation  soon  becomes  white  or  ash- 
colored  ;  if  thick  and  adherent,  brownish  or  buff- 
colored  ;  and  if  stained  by  slight  hemorrhage,  black¬ 
ish.  The  exudation  is  sometimes  very  loosely,  at  others 
very  firmly,  adherent  to  the  subjacent  surface ;  and  occa¬ 
sionally,  especially  when  of  the  friable,  granular  variety, 
is  merely  superimposed  upon  the  natural  surface. 

“The  mucous  membrane  underneath  the  exudation, 
or  from  which  the  exudation  has  recently  exfoliated,  is 
often  intact,  and  generally  much  congested  and  swollen ; 
sometimes  it  is  white,  opaque,  or  unnaturally  pale  ;  at 
others  it  looks  raw,  the  epithelium  having  been  shed 
with  the  false  membrane.  It  often  presents  an  exco¬ 
riated  and  roughened  appearance;  is  sometimes  ulce¬ 
rated,  and,  more  rarely,  gangrenous.  When  false  mem¬ 
brane,  still  adherent  to  the  mucous  surface,  is  lifted  up, 
it  is  often  seen  to  be  attached  to  the  subjacent  surface 


138 


Diptheeia. 


by  numerous  small  thready  adhesions,  as  though'  pro¬ 
cesses  of  exudation  passed  into  the  mucous  follicles ; 
and,  on  removing  it,  the  mucous  membrane  is  more  or 
less  abundantly  dotted  with  bloody  points. 

aThe  submucous  tissue  is  often  edematous,  infil¬ 
trated  with  blood,  and  sometimes  the  seat  of  interstitial 
exudation.  The  tonsils  are  usually  swollen,  and,  on 
being  cut  into,  are  often  infiltrated  with  blood,  so  as  to 
impart  to  them  an  ecchymosed  appearance  ;  sometimes 
their  tissue  is  softened ;  and  in  two  instances  I  have 
found  the  center  of  a  tonsil  in  a  state  bordering  on 
gangrene.  There  is  generally  more  or  less  of  inflam¬ 
matory  effusion  into  the  structure  of  the  tonsils ;  and 
in  one  instance,  on  the  tonsil  being  laid  open,  there 
was  an  oozing  from  it  of  a  creamy  fluid  resembling 
pus.  In  some  instances,  the  esophagus  and  the  mus¬ 
cular  and  other  tissues  around  the  fauces  are  congested 
or  infiltrated  with  blood ;  the  parotid  and  submaxillary 
regions  are  much  swollen,  and  the  integuments  studded 
with  livid  purpurous  spots.  In  a  case  mentioned  to 
me  by  Mr.  Jauncy,  of  Birmingham,  an  abscess  was 
found  between  the  pharynx  and  vertebrae.  The  case 
was  that  of  a  child,  aged  six  years,  which  died  after 
an  illness  of  nine  or  ten  days,  croupy  symptoms  having 
set  in  three  days  previous  to  death : 

“  ‘The  lungs  were  emphysematous  in  front,  collapsed 
in  patches  posteriorly.  A  portion  of  false  membrane 
was  found  at  the  bifurcation  of  the  trachea,  which  was 
elsewhere  free  from  exudation,  but  reddened.  The 
larynx,  epiglottis,  pharynx,  tonsils,  and  uvula  were 
covered  with  lymph.  An  abscess  about  the  size  of  a 
walnut  was  found  between  the  pharynx  and  vertebrae. 
Liver,  kidneys,  and  spleen  healthy.  The  kidneys  were 
examined  microscopically.5 


Morbid  Anatomy. 


139 


u  "When  the  disease  extends  to  the  larynx  and  tra¬ 
chea,  the  false  membrane  generally  becomes  thinner 
and  less  consistent  as  it  descends  in  the  tube,  until  it 
disappears  gradually  in  the  form  either  of  a  very  thin 
pellicle,  or  of  a  creamy  fluid.  The  mucous  membrane 
of  the  affected  portion  of  the  larynx  and  trachea  is 
generally  more  or  less  congested,  and  often  thickened, 
so  as  to  diminish  the  caliber  of  the  passage,  even  after 
the  false  membrane  has  been  removed,  or  has  come 
away.  The  subjacent  membrane  is  here,  for  the  most 
part,  intact ;  but  sometimes,  being  denuded  of  its  epi¬ 
thelium,  exhibits,  on  the  removal  of  the  exudation,  a 
red  excoriated  appearance,  somewhat  like  the  raw  sur¬ 
face  produced  by  a  blister.  It  also,  under  the  same 
circumstances,  presents  small  bloody  points  similar  to 
those  observed  on  the  mucous  membrane  of  the  pha¬ 
rynx.  The  epiglottis,  besides  being  covered  above  or 
below,  or  on  both  sides,  with  exudation,  is  likewise 
often  swollen  so  as  to  contract  the  entrance  to  the 
windpipe.  The  bronchial  tubes  are  sometimes  lined 
with  false  membrane  down  to  the  third  or  fourth  bifur¬ 
cations,  and  even  lower;  and  the  lungs,  sometimes 
partly  emphysematous,  are  also  liable  to  be  affected 
with  pneumonia,  which  is  most  commonly  of  the  lobu¬ 
lar  form.  In  the  latter  case,  the  little  bits  of  spleni- 
fied  lung  are  sometimes  surrounded  by  crepitating  and 
comparatively  healthy  lung,  sometimes  by  portions  of 
emphysematous  lung. 

The  kidneys  have  sometimes  been  found  quite  healthy 
after  death  from  cliptheria ;  in  other  cases  they  have 
been  congested,  and,  on  being  sliced,  have  exhibited 
under  the  microscope  transparent  fibrinous  casts  of  the 
tubes.  The  urine,  in  such  cases,  is  generally  albumin¬ 
ous,  and  also  presents  under  the  microscope  fibrinous 


140 


Diptheria. 


casts  of  tlie  tubes,  which  occasionally  contain  blood 
corpuscles,  or  granules  of  hematine,  or  a  few  altered 
epithelial  cells. 

“In  a  . case  briefly  referred  to  by  Dr.  Gull,  in  his 
communication  to  the  medical  officer  of  the  Privy 
Council,  the  membranes  of  the  brain  and  cord  were  in 
a  state  of  suppurative  inflammation,  the  subarachnoid 
space  being  full  of  soft,  purulent  lymph;  and  the  same 
physician,  although  he  gives  no  post-mortem  facts  in 
support  of  the  opinion,  suggests  that  the  original  seat 
of  the  disease  being  near  the  cervical  portion  of  the 
spinal  cord,  the  paralytic  symptoms  so  common  in  a 
late  stage  of  diptheria  may  arise  from  the  disease  hav¬ 
ing  extended  by  continuity,  from  the  fauces  to  the  upper 
part  of  the  cord.  At  present,  this  opinion  can  only 
be  received  as  suggesting  a  careful  examination  of  the 
cord  in  future  post-mortem  examinations  ;  for  thus  only 
can  it  be  determined  whether  the  paralytic  affection 
has  a  constitutional  origin,  or  arises  from  the  supposed 
local  disease. 

“  In  a  case  related  by  Dr.  Bristowe,  and  exhibited 
by  him  at  the  Pathological  Society,  the  muscular  tissue 
of  the  heart  was  colored  with  extravasated  blood. 
And  in  a  more  recent  case,  treated  by  the  same  physi¬ 
cian  in  St.  Thomas’s  Hospital,  in  which  I  had  the 
opportunity  of  examining  the  organs  after  death,  the 
heart  was  studded  with  petechial  spots  on  its  outer 
surface. 

“  The  following  cases  are  adduced  in  illustration  of 
some  of  the  points  mentioned  in  the  preceding  account 
of  the  morbid  anatomy  of  diptheria.  The  first  has 
been  selected  because  it  well  shows  the  tendency  of 
the  disease  to  become  engrafted,  so  to  speak,  on  other 
disorders,  especially  the  eruptive  fevers;  the  others, 


Morbid  Anatomy. 


141 


mainly  on  account  of  tlie  detailed  description  of  the 
microscopical  appearances  noted  by  sncli  competent 
observers  as  Mr.  Simon  and  Dr.  Bristowe. 

“  S.  Beard,  aged  four  years,  was  admitted  a  patient 
of  the  Western  General  Dispensary,  under  the  care  of 
my  colleague,  Dr.  Sanderson,  on  June  29,  1859.  She 
had  been  taken  ill  on  the  previous  day  with  the  pre¬ 
monitory  symptoms  of  measles,  and  was  visited  by  the 
house  surgeon,  Mr.  Plaskitt.  It  was  not  until  the  4th 
of  July  that  she  complained  of  her  throat ;  and  she 
first  came  under  the  observation  of  Dr.  Sanderson  on 
the  6th  of  that  month.  The  skin  was  then  of  a  not 
unnatural  warmth ;  the  countenance  was  pale,  and  its 
expression  rather  distressed.  The  child  was  somewhat 
drowsy,  and  difficult  to  rouse  ;  there  was  a  slight  dis¬ 
charge  from  the  nostrils,  which  were  lined  with  coagu¬ 
lated  blood  arising  from  an  epistaxis  on  the  previous 
day.  Respiration  natural  in  frequency ;  pulse  120  ; 
the  mucous  membrane  covering  the  tonsils  was  of  a 
deep-red  color,  but  less  bright  than  is  usual  in  ordinary 
tonsillitis.  The  anterior  surface  of  the  uvula  was  bare, 
but  the  posterior  surface  and  sides  wTere  covered  with 
a  soft  concretion,  capable  of  being  detached,  and  evi¬ 
dently  of  slight  consistence.  All  the  parts  were 
smeared  with  a  tenacious  mucus,  which  was  constantly 
being  discharged  from  the  mouth  ;  and  flakes  of  con¬ 
cretion,  which  had  been  excreted  during  the  preceding 
night,  were  exhibited  by  the  mother.  There  was  very 
little  external  swelling  or  tenderness  about  the  neck, 
and  the  breathing  was  not  at  all  crc-upy,  although  said 
to  have  been  so.  Brine  intensely  albuminous. 

il  July  7. — A  tubular  cast,  of  soft  consistence,  distinct¬ 
ly  marked  by  the  laryngeal  rings,  was  discharged  dur¬ 
ing  the  night. 


142 


Diptiieeia. 


“  July  8. — Much  worse ;  feet  and  hands  warm  ;  belly 
hot.  Pulse  160,  feeble,  and  very  difficult  to  count; 
respirations  about  30.  Prolonged,  somewhat  musical 
expiration  sound,  varying  in  tone  from  minute  to  min¬ 
ute  ;  inspiration  sound,  short,  less  noisy,  and  not  musi¬ 
cal.  Countenance  pale,  but  not  livid.  Yoice  resembled 
a  shrill  whisper  heard  through  a  long  tube.  The  cough, 
which  occurred  occasionally,  was  very  short,  and  pre¬ 
cisely  similar  in  tone  to  the  voice.  A  few  small  shreds 
of  concretion  were  still  attached  to  the  uvula  and  vel¬ 
um  ;  but  none  elsewhere.  There  were  excoriations  at 
the  corners  of  the  mouth,  not  covered  with  concretion. 
Mucous  surface  of  a  deep-crimson  hue. 

“  Vesper e. — Respiration  increased  in  frequency  to  40 
in  the  minute  ;  countenance  more  indicative  of  distress. 
She  died  at  seven  a.m.,  on  the  9th. 

u  Post-mortem  Examination  (made  June  10,  twenty- 
seven  .hours  after  death). — Slight  mottling  on  the  arms, 
probably  the  remains  of  the  eruption  of  measles.  The 
upper  surface  of  the  tongue  was  healthy  as  far  back¬ 
ward  as  the  base  of  the  epiglottis,  excepting  that  there 
was  a  small  patch  of  exudation,  not  much  larger  than 
a  grain  of  wheat,  adherent  to  one  of  the  large  papillae. 
The  subjacent  surface  was  healthy  ;  both  tonsils,  espe¬ 
cially  the  right,  were  vascular,  and  presented  a  pitted, 
roughened  appearance.  The  mucous  membrane  cover¬ 
ing  the  margin  of  the  epiglottis,  epiglottidean  folds, 
and  arytenoid  cartilages,  was  white  and  opaque.  The 
anterior  portion  and  edges  of  the  upper  surface  of  the 
epiglottis  were  of  a  brownish- white  color.  The  mu¬ 
cous  membrane  of  a  cavity  behind  the  left  tonsil  and 
between  it  and  the  posterior  pillar  of  the  fauces  con¬ 
tained  a  creamy-looking  exudation.  The  corresponding 
hollow  on  the  right  side  was  free  from  exudation.  The 


Morbid  Anatomy. 


143 


substance  of  the  tonsils,  particularly  of  the  right,  was 
decidedly  softened.  On  being  incised,  they  exhibited 
patches  of  extravasation  and  of  pigmentary  discolora¬ 
tion;  but  in  other  respects  the  section  presented  a 
natural  aspect.  The  mucous  membrane  of  the  larynx 
and  trachea  was  unnaturally  white  and  opaque,  as 
though  covered  with  exudation ;  but  nothing  could  be 
stripped  off  it.  This  condition  of  the  membrane  be¬ 
came  less  and  less  obvious  in  a  downward  direction. 
Here  and  there  were  seen  punctuated  patches  of  red¬ 
ness,  which  sometimes  followed  the  intervals  between 
the  rings  of  the  trachea.  Several  loose  fragments 
of  exudation,  some  of  which,  although  readily  de¬ 
tached,  were  still  adherent  to  the  natural  surface,  were 
found  in  the  upper  part  of  the  trachea.  The  subjacent 
mucous  membrane  was  unbroken,  and  closely  resem¬ 
bled  the  surrounding  mucous  surface. 

u  The  apex  and  upper  portion  of  the  left  lung,  as  far 
as  a  line  extending  upward  and  backward  from  the 
notch,  was  emphysematous,  and  along  the  free  mar¬ 
gin  were  emphysematous  lobules,  surrounded  by  por¬ 
tions  of  splenified  lung.  The  lingua  and  margin  of 
notch  were  completely  splenified.  The  secondary  di¬ 
vision  of  the  bronchus  leading  to  the  apex  of  the  left 
lung  contained  cylindrical  casts,  of  about  the  consist¬ 
ence  of  boiled  macaroni,  at  their  proximate  extremity, 
but  diminishing  in  consistency  until  they  disappeared 
in  the  third  or  fourth  division  of  the  bronchus,  in  the 
form  of  creamy-looking  fluid.  The  division  of  the 
bronchus  leading  to  the  lower  lobe  contained  no  casts, 
excepting  in  one  of  the  tertiary  divisions  leading  to¬ 
ward  its  posterior  aspect.  It  was  not  ascertained 
whether  or  not  this  portion  of  exudation  was  continu¬ 
ous  with  that  in  the  bronchus  leading  to  the  apex. 


144 


Diptheria. 


The  mucous  membrane  was  .for  the  most  part  remark¬ 
ably  pale,  but  otherwise  healthy.  There  was  bronchi¬ 
tis  in  a  few  of  the  smaller  tubes,  as  shown  by  the 
frothy  secretion  which  they  contained,  and  by  slight 
vascularity.  The  parenchyma  was  firmly  splenified 
throughout  the  lower  lobe,  with  here  and  there  scat¬ 
tered  portions  of  emphysematous  lung. 

“  The  two  upper  lobes  of  the  right  lung  were  em¬ 
physematous  ;  the  lower  lobe  was  also  emphysema¬ 
tous  at  the  upper  portion,  and  partially  so  below.  The 
bronchus  leading  to  the  apex  contained  here  and  there 
adherent,  but  also  partly  detached,  patches  or  frag¬ 
ments  of  soft  exudation,  which  ceased  rather  abruptly 
in  the  third  bifurcation,  and  less  decidedly  terminated 
in  creamy  fluid  than  those  on  the  left  side.  A  consid¬ 
erable-sized  tube  leading  toward  the  base  of  the  upper 
lobe  was  choked  with  a  cylindrical  mass  of  semi-dif¬ 
fluent  white  and  opaque  secretion,  which,  under  the 
microscope,  exhibited  cells  without  fibrinated  matrix. 
The  bronchial  branches  leading  to  the  middle  and 
lower  lobes  were  free  from  exudation.  The  mucous 
membrane  of  the  tubes  in  the  upper  lobe,  like  that  on 
the  left  side,  was  perfectly  white.  That  of  the  tubes 
leading  to  the  middle  and  lower  lobes  on  the  right 
side  markedly  injected. 

“  The  following  case,  communicated  to  the  Patholog¬ 
ical  Society  by  Mr.  Simon,  is  quoted  from  the  Transac¬ 
tions  of  that  Society  for  last  year  : 

“  {  A.  II.,  set.  thirteen,  had  been  suffering  from  dip- 
theria  for  nineteen  days  before  his  death,  and  during 
the  last  eleven  had  been  under  treatment  in  St. 
Thomas’s  Hospital.  On  the  eighth  day  of  the  disease 
a  large  mass  of  thick,  dense,  very  fibrinous  false  mem¬ 
brane  detached  itself  from  the  fauces,  leaving  the  sur- 


Morbid  Anatomy. 


145 


face  of  the  tonsils  and  soft  palate  raw  (like  that  of  skin 
from  which  the  cuticle  has  been  removed  after  blister¬ 
ing),  but  not  ulcerated  or  sloughing.  On  part  of 
this  surface,  a  second  thinner  false  membrane  soon 
formed,  and  subsequently  came  away  in  shreds.  There 
was  irritating  discharge  from  the  nose,  and  during  the 
last  days  of  life  some  of  the  patient’s  drink  escaped 
this  way.  Early  in  the  disease  there  had  been  swell¬ 
ing  below  the  jaw,  but  this  had  subsided  many  days 
before  death.  On  the  seventeenth  day  of  the  disease 
superficial  ulceration  began  at  the  left  tonsil,  and  on 
the  eighteenth  day  had  extended  to  the  size  of  a  shil¬ 
ling.  On  each  of  the  last  eleven  days  of  life  the  urine 
was  examined ;  it  always  gave  abundant  precipitate 
with  nitric  acid,  and  latterly  also  with  heat ;  but 
in  the  earlier  days  it  precipitated  imperfectly  with 
heat,  and  largely  with  acetic  acid.  Microscopically 
it  showed  fibrinous  tubule-casts,  containing  traces 
of  hemorrhage,  but  scarcely  any  renal  epithelium. 
Throughout  the  progress  of  the  disease  the  patient  was 
pale,  feeble,  and  disposed  to  be  chilly,  so  that  wine 
and  much  external  warmth  had  from  the  first  been 
necessary.  The  tongue  was  always  moist.  Mo  erup¬ 
tion  appeared  upon  the  skin.  There  was  no  delirium 
or  stupor,  and  neither  cough  nor  any  sign  of  laryngeal 
obstruction  was  observed.  The  respiration  was  natural 
till  within  a  few  hours  of  death,  when  it  became  short 
and  hurried. 

“  ‘  The  following  were  the  post-mortem  appearances  : 
With  the  exception  of  an  occasional  very  delicate  film, 
there  was  no  false  membrane  about  the  fauces.  In  the 
situation  of  the  left  tonsil  was  a  sloughy  ulcer,  some¬ 
what  larger  than  a  shilling.  The  posterior  surface  of 
the  soft  palate  was  congested,  and  there  adhered  to  its 

7 


146 


Diptheeia. 


somewhat  swollen  mucons  membrane  small  patches  of 
false  membrane.  In  the  recess  of  mncons  membrane 
beside  the  epiglottis  was  an  irregular  depression,  evi¬ 
dently  the  remains  of  an  almost  cicatrized  ulcer. 
About  an  inch  below  the  aperture  of  the  glottis,  the 
pharynx  presented  on  its  right  side  a  small  circular 
ulcer,  about  two  lines  in  diameter,  with  somewhat 
raised  margins,  and  on  the  left  side  another  similar 
ulcer,  about  the  size  of  a  pin’s  head.  In  other  respects 
the  pharynx  and  esophagus  were  healthy.  On  wash¬ 
ing  out  the  nares  a  strip  of  false  membrane  an  inch  in 
length  was  removed.  The  mucons  membrane  covering 
the  septum  showed  patches  of  congestion,  was  thicken¬ 
ed,  and  had  shreds  of  false  membrane  adherent  to  it. 

“  6  Both  lungs,  except  in  their  upper  and  anterior 
parts,  were  greatly  congested  with  blood,  and  less 
crepitant  than  is  natural,  especially  the  lower  lobes, 
whose  posterior  parts  were  in  many  places  nearly  or 
quite  without  air;  and  the  most  solidified  portions 
broke  down  on  firm  pressure  with  the  finger.  At  one 
section  the  exuding  fluid  was  obviously  purulent,  and 
microscopical  examination  showed  pus  extensively  in 
other  parts  of  the  hepatized  structure.  The  bronchial 
mucous  membrane  was  a  little  injected ;  the  tubes  con¬ 
tained  thin  frothy  fluid  tinged  with  blood,  or  more 
tenacious  reddened  mucus. 

u  4  The  kidneys  were  large,  and  intensely  congested. 
Sections  of  the  cortex,  microscopically  examined, 
showed  frequently  the  presence  of  large,  transparent, 
colorless  rods  of  apparently  fibrinous  material,  soluble 
in  acetic  acid  and  liquor  pottassse.  These  rods  were 
sometimes  floating  free,  sometimes  partly  or  wholly 
held  within  urinary  tubules,  of  which  evidently  they 
were  casts.  They  were  generally  structureless,  but  (no 


Morbid  Anatomy. 


147 


doubt  from  the  manner  of  their  formation)  had  a  dis¬ 
position  to  transverse  fracture,  and  sometimes  presented 
lines  curving  almost  concentrically  across  them,  or 
had  this  direction  given  to  little  clusters  of  granular 
matter,  probably  altered  epithelium,  which  they  occa¬ 
sionally  contained.  Apart  from  the  presence  of  these 
casts,  the  tubular  structure  of  the  kidney  was  not  very 
obviously  diseased  ;  but,  after  prolonged  and  careful 
observation,  it  could  confidently  be  said,  that,  at  least 
in  many  parts,  the  cell-growth  within  it  was  redundant, 
so  that  the  tubules  were  more  opaque  than  natural, 
and  had  their  interior  canal  encroached  upon,  or  even 
quite  occluded  by  an  increased  amount  of  epithelium. 
The  Malpighian  tufts  within  their  capsules  showed  a 
little  indistinctly. 

“  £  The  venous  system  was  everywhere  remarkably 
full  of  blood  ;  the  liver  was  greatly  congested ;  the 
heart  was  healthy,  with  a  firm  coagulum  in  each  of  its 
four  cavities.’ 

u  The  next  case,  also  taken  from  the  Transactions  of 
the  Pathological  Society ,  is  from  a  communication  by 
Dr.  Bristowe : 

“  4  T.  1ST.,  set.  ten,  the  son  of  a  farm-laborer,  was  ad¬ 
mitted  into  St.  Thomas’s  Hospital,  under  Mr.  Solly’s 
care,  on  the  12th  of  November,  1858,  with  contraction 
of  the  left  wrist  and  elbow-joints,  after  a  burn.  On 
the  18th  he  was  operated  upon,  and  continued  under 
mechanical  treatment  up  to  the  commencement  of  the 
malady  of  which  he  died.  He  appeared  perfectly  well 
on  the  20th  of  March,  1859,  but  on  that  day  partook 
of  some  gin  and  other  improper  articles  of  diet.  The 
following  morning  he  had  a  slight  attack  of  shivering, 
and  seemed  otherwise  a  little  indisposed.  On  the  22d 
he  complained  of  slight  soreness  of  the  throat.  This 


148 


Diptherxa.. 


increased,  and  on  the  24th  the  following  notes  were 
taken  by  the  surgical  register : 

“ ‘  Throat  much  swollen  externally,  particularly  on 
the  right  side.  On  looking  into  it,  the  right  tonsil  is 
seen  filling  up  the  fauces,  and  has  upon  it  a  pultaceous 
material.  Pulse  small  and  weak,  130;  tongue  furred; 
skin  cool.’ 

“  ‘  On  the  25th  he  wTas  placed  under  my  care.  He 
has  slept  a  little  in  the  night,  and  is  said  to  be  now 
rather  better  than  he  has  been.  He  is  extremely  fee¬ 
ble,  however,  not  at  all  feverish,  and  perfectly  rational. 
The  skin  is  cool,  and  gives  no  indication  of  rash.  Pulse 
small,  weak,  slightly  irregular,  and  about  100.  There 
is  great  tumefaction,  hardness,  and  tenderness  in  the 
upper  part  of  the  throat,  chiefly  in  the  parotid  and 
submaxillary  regions,  and  more  on  the  right  side  than 
on  the  left.  The  anterior  half  of  the  tongue  is  clean, 
and  its  papillae  are  healthy  ;  the  posterior  half  is  some¬ 
what  furred.  The  right  tonsil  is  much  swollen,  and 
covered  by  a  thick  wash-leather-like  false  membrane, 
which  is  prolonged  from  it  on  to  the  pillars  of  the 
fauces,  over  the  right  half  of  the  soft  palate,  and  to 
the  edges  of  the  posterior  teeth.  The  nose  bled  this 
morning,  and  a  little  thin  sanious  fluid  has  continued 
to  ooze  from  it.  Has  no  pain  anywhere  except  in  the 
throat ;  experiences  pain  and  difficulty  in  swallowing, 
but  can  manage  to  take  fluids.  Ho  cough  or  difficulty 
of  breathing.  Bowels  opened  yesterday. 

“ £  March  26,  two  p.m. — Slept  pretty  well,  but  is 
much  worse  than  he  was.  Skin  cold,  without  trace  of 
rash.  Pulse  quite  imperceptible.  Throat  more  swol¬ 
len,  hard,  painful  on  pressure,  and  studded  on  the  right 
side  with  small  congested  points.  Tongue  dryish,  but 
not  much  furred.  The  breath  has  a  faint,  gangrenous 


Morbid  Anatomy. 


149 


ocTor.  There  is  no  appreciable  change  in  the  condi¬ 
tion  of  the  interior  of  the  throat.  Is  quite  sensible, 
but  very  restless.  IIo  cough,  or  embarrassment  in 
breathing.  Tie  continued  to  sink,  and  died  at  half¬ 
past  five,  p.m.,  remaining  sensible  to  the  last.’ 

“  The  following  were  the  post-mortem  appearances : 

“  ‘  The  front  and  sides  of  the  throat  were  thick  and 
brawny ;  and  the  parotid  and  submaxillary  regions 
were  much  swollen  and  hardened,  especially  on  the 
right  side,  where  also  the  integuments  were  studded 
with  congested  and  livid  spots.  On  cutting  into  the 
neck,  its  muscular  and  cellular  tissues,  from  the  integ¬ 
uments  to  the  vertebrse,  and  from  the  ears  and  root  of 
the  tongue  to  the  upper  opening  of  the  thorax,  were 
found  indurated  and  brawny,  and  so  infiltrated  with 
blood  as  to  be  everywhere  almost  black.  There  were 
no  circumscribed  fluid  or  clotted  collections,  but  the 
blood  was  uniformly  diffused  throughout  the  tissues. 
There  was  no  appearance  of  pus,  and  no  visible  indi¬ 
cation  of  inflammatory  deposit. 

“  £  The  soft  palate  and  uvula,  the  tonsils  and  pillars 
of  the  fauces,  the  esophagus  and  larynx,  were  all  in¬ 
tensely  and  deeply  congested,  tumid,  brawny,  and 
covered  in  many  places  by  toughish,  adherent,  ashy, 
false  membrane,  or  by  pultaceous  puriform  exudation. 
The  soft  palate  was  quite  half  an  inch  thick,  infiltrated 
with  blood,  and  studded  with  shreds  of  false  mem¬ 
brane.  The  tonsils  were  swelled,  but  at  the  same  time 
presented  deep  fissures  and  excavations,  and  were 
covered  pretty  completely  by  grayish-yellow  false 
membrane.  This  was  in  parts  thick,  tough,  and  pretty 
firmly  adherent ;  but  over  the  convexity  of  the  tonsils 
became  changed  into  a  soft,  pultaceous  deposit,  which 
seemed  partly  pus  and  partly  superficial  slough.  On  in- 


150 


Diptheria. 


cising  the  left  tonsil  it  was  found  softened,  deeply  con¬ 
gested,  partly  infiltrated  with  blood,  and  studded  with 
distinct  pus-holding  cavities ;  and  the  surfaces  of  the 
fissures  passing  into  it  from  the  surface  were  soft, 
greenish,  and  slightly  gangrenous.  The  right  tonsil 
was  generally  in  the  same  condition  as  the  left,  but 
presented  several  deep,  distinctly  gangrenous,  fetid  ex¬ 
cavations.  The  mucous  surface  at  the  base  of  the 
tongue  and  back  of  the  pharynx  was  congested,  and 
presented  here  and  there  shreds  of  adherent  membrane. 
The  mucous  investment  of  the  epiglottis,  and  indeed 
that  of  the  whole  larynx,  were  thickened,  indurated, 
and  deeply  congested.  The  epiglottis  was  covered 
pretty  extensively  by  a  toughish  adherent  membrane, 
about  half  a  line  thick  ;  and  a  similar  formation,  in 
less  abundance,  was  studded  over  the  rest  of  the  laryn¬ 
geal  surface,  and  accumulated  along  the  vocal  cords. 
The  trachea  was  congested,  but  otherwise  healthy ;  the 
esophagus  also  was  healthy ;  but  the  tissues  immedi¬ 
ately  surrounding  them,  like  those  of  the  rest  of  the 
neck,  were  infiltrated  with  blood.  Several  portions  of 
the  hard  palate,  and  septum  nasi,  were  removed,  and 
their  mucous  covering  was  found  congested,  and  lined 
by  adherent  false  membrane. 

“  ‘  Pericardium  healthy.  Heart  small,  firmly  con¬ 
tracted,  and  nearly  empty,  its  auricle  and  right  ven¬ 
tricle  containing  a  little  fibrinous  clot  only.  The  valves 
were  healthy.  The  muscular  tissue  was  generally  pale ; 
but  almost  all  the  musculi  papillares  and  carnese  co- 
lumnse  of  the  left  ventricle,  and  the  walls  of  the  apical 
half  in  nearly  their  whole  area,  and  to  a  depth  varying 
irregularly  from  a  quarter  of  an  inch  downward,  were 
almost  black  from  sanguineous  infiltration.  The  same 
condition  was  observed  in  the  right  ventricle,  but  to  a 


Morbid  Anatomy. 


151 


less  extent,  the  papillary  muscles  and  the  parietes  being 
studded  irregularly  and  thickly  with  black,  blood-in¬ 
filtrated  patches  of  various  sizes ;  some  so  thick  as  to 
reach  the  external  surface  of  the  organ,  and  some  dotted 
with  white  spots  and  patches,  which  looked  at  first  sight 
like  suppurating  points. 

“  ‘  Pleurse  healthy.  Lungs  crepitant  throughout, 
and  not  materially  congested.  They  presented,  how¬ 
ever,  on  their  external  surface,  a  few  dark-red,  almost 
black  spots,  about  a  quarter  of  an  inch  in  diameter, 
which  were  found  to  correspond  to  small  subjacent 
patches  of  solid,  dark-colored,  granular  lung  tissue. 
The  bronchial  tubes  contained  much  secretion. 

“  ‘  Peritonium  healthy.  Liver  of  usual  size,  gene¬ 
rally  of  normal  color  and  consistence ;  its  surface  and 
substance,  however,  were  thinly  studded  with  petechial 
spots.  Spleen  of  usual  size,  pale,  and  of  moderate 
consistence.  There  was  a  little  effusion  of  blood  in  the 
sub-mucous  and  cellular  tissues  around  the  pancreas 
and  supra-renal  capsules ;  and  the  latter  organs  pre¬ 
sented  patches  of  extravasated  blood  in  the  interior, 
though  apparently  in  other  respects  healthy.  The 
cellular  tissue  of  the  mesentery  was  studded  pretty 
thickly  with  small,  and  not  very  intensely-colored 
patches  of  congestion  and  extravasation.  The  stomach 
and  intestines  were  healthy,  but  the  ilium  contained 
two  lumbrici.  The  kidneys  were  of  the  usual  size,  pale, 
and  apparently  perfectly  healthy.  Aorta  and  vena 
cava  healthy. 

“  4  The  false  membrane  about  the  fauces  and  neigh¬ 
boring  parts  was  made  up  chiefly  of  a  net-work  of 
fibrillated  lymph.  The  fibrillse  were  very  irregular  in 
outline  and  dimensions,  but  generally  comparatively 
thick ;  and  they  coalesced  with  one  another  in  all  di- 


152 


Dipthekia. 


rections,  so  as  to  leave  irregular  spaces  between  them;' 
wliicli  were  small,  and  often  not  larger  in  diameter 
than  the  fibrillse  themselves.  When  seen  in  thickness, 
the  tissue  above  described  presented  a  pebbly  charac¬ 
ter,  like  that  afforded  by  an  accumulation  of  nuclei ; 
but  the  fallacious  nature  of  this  appearance  was  recog¬ 
nized  on  looking  at  the  thin  edge  of  a  section  ;  or  by 
adding  acetic  acid,  which  rendered  the  whole  transpa¬ 
rent,  at  the  same  time  expanding  it,  and  bringing  into 
view  an  exceedingly  delicate  and  irregular  net- work  of 
well  and  sharply-defined,  occasionally  bulging,  fibers, 
which  appeared  to  be,  so  to  speak,  the  skeleton  of  the 
original  net-work.  In  some  places  the  false  membrane 
consisted  of  an  apparently  uniform  layer,  composed  of 
an  extremely  fine  and  indistinctly  fibrillated  tissue, 
studded  with  molecular  matter,  and  presenting  some¬ 
thing  of  a  ground-glass  character.  Imperfect  epithe¬ 
lium  was  entangled  here  and  there  in  the  substance  of 
the  membrane,  but  was  most  abundant  on  the  super¬ 
ficial  surface. 

“  4  The  pus-like  fluid  in  the  tonsils  consisted  of  well- 
marked  pus-cells  characteristically  affected  by  acetic 
acid.  Some  of  the  muscular  tissue  from  the  small 
muscles  of  the  larynx  and  from  those  of  the  neck  was 
examined,  and  found  to  be  striated  and  healthy-look- 
ing;  but  the  spaces  between  the  fibers  were  loaded 
with  blood-corpuscles.  The  cellular  tissue  in  front  of 
the  epiglottis  presented  a  net-work  of  fibrillated  tissue 
like  that  constituting  the  false  membrane  itself ;  but 
the  meshes  were  larger  and  more  distinct.  The  mus¬ 
cular  tissue  of  the  heart  was  found  to  be  generally  in 
an  early  stage  of  fatty  degeneration,  the  transverse 
markings  being  nearly  absent,  and  the  fibers  studded 
with  minute  molecules.  But  in  the  portions  infiltrated 


Morbid  Anatomy. 


153 


with  blood  the  degeneration  was  more  advanced  than 
elsewhere,  the  striae  were  wholly  deficient,  the  fibers 
crowded,  and  in  some  cases  opaque,  with  beads  of  oil, 
many  of  which  were  of  considerable  size.  The  white 
pus-like  spots  in  the  right  ventricle  consisted  simply 
of  muscular  fibers  extremely  degenerated. 

u  ‘  The  kidneys,  though  looking  healthy  to  the  naked 
eye,  were  really  much  diseased.  The  Malphigian 
bodies  were  generally  healthy,  but  a  few  presented 
accumulations  of  oily  granules  between  the  capsule, 
and  contained  tufts  of  vessels.  The  epithelium  of  the 
tubes  was  generally  opaque  and  granular.  In  many 
instances  the  peripheral  surface  of  the  cylinder  of  cells 
presented  numerous  oily  globules ;  and  not  infre¬ 
quently  the  tubes  appeared  filled  with  separated  and 
irregularly  clustered  epithelial  cells,  loaded  with  oil  so 
as  to  be  almost  opaque.  In  a  few  cases,  tubes  were 
filled  with  recently  extravasated  blood  ;  and  occasion¬ 
ally  transparent  casts  were  seen  floating  about  the 
field  of  the  microscope.  The  contents  of  the  medul¬ 
lary  tubules  were  more  generally  unhealthy  even  than 
those  of  the  cortical  ones.  Many  contained  transparent 
fibrinous  casts,  and  the  majority  presented  oily,  break¬ 
ing  down,  epithelial  contents.5 

“I  am  indebted  to  Dr.  Bristowe  for  the  following 
report  of  a  case,  which  recently  proved  fatal  in  St. 
Thomas’s  Hospital.  I  had  not  the  opportunity  of  see¬ 
ing  the  patient  during  life,  but  carefully  examined  the 
affected  organs  after  death. 

“  E.  T.,  a  girl,  aged  eleven  years,  suffering  from 
club-foot,  had  been  in  St.  Thomas’s  Hospital,  under 
Mr.  Solly’s  treatment,  since  May  22,  1860.  On  the 
evening  of  June  23d,  she  first  complained  of  sore 
throat.  This  increased  in  severity  during  the  next  few 


154 


Diptheria. 


days ;  pain  and  difficulty  of  swallowing  came  on,  and 
on  the  afternoon  of  the  27  th  she  was  placed  under  the 
care  of  Dr.  Bristowe.  There  had  been  no  marked 
febrile  symptoms,  no  shivering,  headache,  or  pains  in 
the  limbs.  Neither  in  the  ward  nor  among  the  child’s 
friends  had  there  been  any  cases  of  scarlet  fever  or 
diptheria;  but  a  little  girl  in  an  adjoining  bed  had 
been  attacked,  much  about  the  same  time,  with  a  sore 
throat,  which  had  disappeared  in  a  day  or  two,  and 
presented  no  unusual  character. 

“  ‘ June  27. — Is  perfectly  sensible  and  composed,  hav- 
ing  by  no  means  the  aspect  of  a  person  seriously  ill. 
Has  no  headache,  or  pains  about  the  limbs;  complains 
of  a  little  thirst  and  loss  of  appetite,  but  no  sickness, 
cough,  or  difficulty  of  breathing.  Pulse  124.  The 
pupils  are  natural.  The  skin  is  warm,  but  not  dry, 
and  without  trace  of  rash.  The  external  fauces  on  the 
right  side  are  much  swollen,  very  tense  and  tender, 
but  not  discolored.  On  looking  into  the  throat,  the 
right  tonsil  is  seen  to  be  so  much  enlarged  as  to  appear 
almost  to  close  the  passage,  and  is  covered  in  nearly 
its  whole  extent  by  a  thick,  grayish,  false  membrane. 
The  uvula  is  pushed  over  to  the  left  side,  and  almost 
concealed  ;  is  somewhat  thickened,  and  a  little  false 
membrane  adheres  to  it.  The  left  tonsil  is  hidden,  and 
apparently  not  enlarged.  The  tongue  is  covered  with 
a  whity- brown  fur,  and  its  papillae  are  not  prominent. 

Hirudines  ij.  faucibus  externis.  Catapl.  lini  postea. 

^  Cklorat.  potass.  gr.  iv. 

Add.  bydrocbl.  17)  j . 

Aquas  dist.  f  ss. 

4tis  lioris. 

“ 6  Milk  diet.  Strong  beef  tea.  Two  eggs.  Wine, 
three  glasses. 


Morbid  Anatomy. 


155 


“  1  2 8th. — Passed  a  comfortable  night,  and  has  taken 
all  her  wine  and  nourishment.  The  leeches  have  given 
her  great  relief.  There  is  little  appreciable  change  in 
either  her  general  health  or  in  the  condition  of  the 
throat,  except  that  the  right  side  is  less  tense  and  ten¬ 
der  than  it  was.  The  bowels  are  confined. 

Wine,  4  glasses. 

Puly.  rheei  c.  hydrarg.  Qj.  statim. 

“‘29i th. — Was  very  restless  during  the  night.  The 
bowels  have  been  relieved,  and  she  has  been  very  sick. 
The  skin  is  hot,  and  rather  dry.  No  rash.  Pulse  128. 
No  pains  anywhere  excepting  in  the  throat ;  no  cough 
or  difficulty  of  breathing.  Great  pain  and  difficulty 
of  swallowing.  There  is  copious  discharge  from  the 
nostrils.  Tongue  clean.  The  right  side  of  the  throat 
is  in  the  same  condition  as  yesterday ;  but  the  left  side 
also  is  now  distinctly  swelled  and  painful.  .  The  right 
tonsil  is  about  as  large  as  it  was ;  but  the  membrane, 
which  is  thick  and  tough,  is  detached  and  curled  up  at 
the  margins.  The  left  tonsil  is  somewhat  increased  in 
size,  and  also  presents  a  distinct  false  membrane.  The 
uvula  is  seen  with  difficulty,  but  has  a  few  patches  on 
its  surface.  The  lungs  are  resonant  in  front;  but  the 
respiratory  sounds  are  masked  by  the  noise  produced 
in  the  throat.  Urine  albuminous.  Sp.  gr.  1,015. 
"Wine,  twelve  glasses. 

“  ‘  Toward  the  evening  she  grew  considerably  worse, 
and  became  very  restless.  The  pulse  rose  to  152 ;  a 
troublesome  cough,  at  times  a  little  croupy  in  charac¬ 
ter,  came  on ;  the  breathing  became  rapid  (40  in  the 
minute),  and  more  noisy  than  it  had  been.  She  con¬ 
tinued  perfectly  sensible. 

“  4  30 th,  nine  a.m. — Has  been  very  restless  all  night, 
and  has  taken  very  little  wine  and  nourishment  in  con- 


156 


Diptheeia. 


sequence  of  inability  and  disinclination  to  swallow.  Is 
now  manifestly  sinking ;  is  scarcely  sensible,  but  can 
be  roused  ;  breathing  rapid,  accompanied  by  loud  rat¬ 
tle  and  frequent  moans  ;  pulse  imperceptible ;  lips  dry. 
Died  at  ten  a.m. 

“ ‘  Autopsy. — The  body  was  in  a  fair  condition. 
There  were  no  traces  of  eruption  or  of  desquamation. 
The  right  submaxillary  region  was  much  swelled  and 
indurated ;  the  left  also,  and  the  intervening  parts,  were 
swelled,  though  in  a  less  degree. 

“  £  Chest. — Pericardium  healthy.  Heart  of  natural 
size,  and  for  the  most  part  healthy.  Its  external  sur¬ 
face  presented  numerous  petechial  spots,  and  its  cav¬ 
ities  contained  partly  decolorized  coagula.  The  pleurae 
were  free  from  adhesions,  and  the  upper  lobe  of  the 
left  lung  was  covered  by  a  very  thin  film  of  recent 
granular  lymph.  The  lungs  were  rather  large,  heavier 
than  natural,  and  presented,  when  handled,  the  irreg¬ 
ularly  solidified  character  distinctive  of  lobular  pneu¬ 
monia.  On  section,  the  upper  lobes  of  both  lungs  were 
found  to  furnish  well-marked  specimens  of  the  con¬ 
dition  just  named.  They  were  studded  thickly  with 
smallish  solid  masses,  running  to  some  extent  into  one 
another,  and  separated  by  an  imperfect  net-work  of  still 
crepitant,  though  congested,  lung  tissue.  The  solid 
masses  varied  in  character ;  in  some  instances  were 
distinctly  apoplectic,  in  others  had  the  appearance  of 
being  due  to  simple  carnification,  and  in  others  pre¬ 
sented  various  degrees  of  the  brick-red  tint  and  granu¬ 
lar  condition  belonging  to  red  hepatization.  The  lower 
lobes  were,  in  many  respects,  in  the  same  condition  as 
the  upper ;  but  they  presented  a  greater  degree  of  sim¬ 
ple  collapse,  and,  consequently,  a  less  amount  of  crep¬ 
itant  tissue ;  the  hepatized  and  apoplectic  patches,  too, 


Morbid  Anatom  v. 


157 

were  larger,  and  presented  less  of  the  lobular  arrange¬ 
ment.  The  bronchial  tubes  were  congested,  and  con¬ 
tained  much  frothy  mucus. 

“  4  The  larynx,  trachea,  and  adjacent  parts  were  now 
removed  and  examined.  The  right  tonsil  was  found  to 
be  very  large,  though  scarcely  so  large  as  during  life ; 
the  left  also  was  enlarged,  but  in  a  less  degree  than  its 
fellow ;  and  the  uvula  and  soft  palate  were  somewhat 
thickened.  The  tonsils,  soft  palate,  uvula,  base  of 
tongue,  and  posterior  and  lateral  part  of  pharynx  were 
covered,  more  or  less  completely,  with  tough,  some¬ 
what  elastic,  whitish  false  membrane.  On  the  base  of 
the  tongue  and  uvula  it  formed  merely  thin,  scattered 
patches.  But  over  the  tonsils,  pillars  of  the  fauces, 
and  rest  of  the  pharynx,  it  formed  layers  of  consider¬ 
able  extent,  and  often  more  than  half  a  line  thick.  The 
membrane  had  become  generally  more  or  less  detached 
at- the  edges ;  and  that  portion  connected  with  the  right 
tonsil  had  separated  in  nearly  its  whole  extent,  and 
hung  as  a  loose,  discolored  mass,  backward  into  the 
pharynx.  On  peeling  the  membrane  off,  it  was  found 
pretty  firmly  attached,  and  accurately  molded  to  the 
inequalities  of  the  subjacent  mucous  surface,  which  was 
congested,  but  not  ulcerated.  On  section,  the  tonsils 
were  seen  to  be  deeply  congested  throughout,  some¬ 
what  softened,  and  studded  thickly  with  small  patches 
of  yellowish  (but  not  distinctly  purulent)  inflammatory 
deposit.  The  tissue  of  the  soft  palate  and  uvula  was  a 
little  brawny. 

“  ‘  The  mucous  membrane  of  the  upper  part  of  the 
larynx  was  congested  and  somewhat  thickened  ;  and  a 
thin  false  membrane  covered  the  epiglottis,  extended 
into  the  aryteno-epiglottidean  folds,  and  down  to  the 
superior  vocal  cords.  False  membrane  also  extended 


158 


DlPTHEEIA. 


into  the  sacculi  laryngis ,  and  was  scattered  in  small 
patches  over  the  mucous  membrane  for  about  an  inch 
below.  The  greater  part  of  the  trachea  was  healthy. 

“  ‘  Abdomen. — Peritoneum  healthy.  Liver  healthy, 
but  studded  with  a  few  pallid  patches.  Spleen,  pan¬ 
creas,  and  super-renal  capsules  healthy.  The  mucous 
membrane  of  the  stomach  presented  numerous  petechial 
spots ;  and  Peyer’s  patches  in  the  lower  three  feet  of 
the  ileum  were  remarkably  distinct  and  prominent;  in 
other  respects  the  alimentary  canal  displayed  nothing 
unusual.  The  kidneys  did  not  look  unhealthy ;  but 
exhibited,  in  their  cortical  substance,  alternate  pallid 
and  congested  vertical  streaks.  Uterus  and  ovaries 
healthy.  Larger  blood-vessels  natural. 

“  c  Microscopic  Examination. — The  false  membrane 
was  identical  in  its  intimate  structure  with  those  which 
I  had  formerly  examined  and  described.  The  only 
unnatural  character  exhibited  by  the  kidneys  was,  gen¬ 
eral  great  granularity  of  the  epithelium,  and  conse¬ 
quent  opacity  of  the  undenuded  tubules.  It  seemed, 
too,  as  though  the  individual  cells  were  abnormally 
large.  There  was  no  trace  of  effused  blood,  and  no 
casts.  The  Malpighian  bodies  were  normal.’  ” 

DRUG  TREATMENT  OF  DIPTHERIA. 

* 

"With  all  the  data  before  us  which  careful  observa¬ 
tion,  extensive  experience,  keen  analysis,  history,  mor¬ 
tuary  statistics,  and  morbid  anatomy  can  furnish,  we 
now  approach  the  really  important  and  responsible 
part  of  our  subject — the  treatment  of  diptheria.  All 
persons  who  will  carefully  read  the  history  of  all  the 
wide-spread  epidemics  which  have  prevailed  in  the 
world — the  plague,  the  sweating  sickness,  the  influenza, 


Drug  Treatment. 


159 


the  scarlatina,  the  cholera,  and  the  diptheria — can  not 
fail  to  notice  the  wonderful  harmony  of  medical  au¬ 
thors  in  description  and  diagnosis,  and  the  strange  dis¬ 
cordance  of  medical  practitioners  in  their  manner  of 
treatment.  Physicians  who  agree  precisely  as  to  the 
seat,  character,  and  causes  of  the  disease,  will  recom¬ 
mend  exactly  opposite  methods  of  treatment ;  while 
others  who  disagree  as  to  the  type  and  diathesis  of  the 
malady,  will  agree  in  their  plan  of  medication.  This 
is  not  only  true  of  diptheria  and  other  pestilences,  but 
of  all  diseases.  And  the  explanation  is,  that  the  med¬ 
ical  profession  has  a  false  theory  of  all  diseases — of  the 
nature  of  disease  itself. 

The  majority  of  physicians  recognize  the  diptlieritic 
exudation  to  be  an  inflammatory  process.  But  what 
is  inflammation?  Here  all  is  discord  and  confusion 
again.  “  It  is  increased  action ,  and  must  be  reduced,” 
says  one  ;  and  in  goes  the  lancet,  or  on  go  the  leeches, 
or  down  go  the  emetics,  the  purgatives,  the  antiphlo- 
gistics,  etc.,  and  down  and  off  goes  the  patient. 

“  Inflammation  is  decreased  action,57  says  another, 
“  and  the  patient  must  be  sustained  through  it  ;55  and 
in  and  down  go  brandy  and  quinine,  wine  and  cor¬ 
dials,  beef-tea  and  egg-toddy. 

“  The  inflammation  is  specific”  says  a  third,  a  and 
must  be  specifically  counteracted;55  and  the  mucous 
membrane  is  seared  with  lunar  caustic,  scorched  with 
cayenne  pepper,  burned  with  alcohol,  excoriated  with 
chlorate  of  potassa,  denuded  with  sulphate  of  zinc, 
corroded  with  hydrochloric  acid,  and  constringed  with 
preparations  of  iron. 

“The  local  inflammation' is  active ,”  is  the  doctrine 
of  another;  and  nitrate  of  potassa  and  antimonial  wine 
are  the  remedies. 


160 


Diptheria. 


aThe  local  inflammation  is  passive ,”  exclaims  an¬ 
other  ;  and  aqua  ammonia,  and  mustard  poultices,  and 
turpentine  liniments,  and  alcoholic  gargles  are  in  requi¬ 
sition. 

“  The  exudation  is  a  parasitic  fungus ,”  replies  an¬ 
other  ;  and  death  to  the  animalcules  is  dealt  out  in  the 
shape  of  calomel,  nitrate  of  silver,  anguintum,  sul¬ 
phur,  arsenic,  iodine,  iron,  salt,  alum,  etc. 

“  But  the  chief  difficulty  lies  further  back ;  it  is  a 
Mood  disease ,”  says  another ;  and  so  he  attacks  the 
virus  by  sending  an  antidote,  a  counter-poison,  a  drug, 
a  medicine  into  the  blood,  in  the  vain  expectation  that, 
in  some  mysterious  manner  the  poison  he  sends  into 
the  system  will  neutralize  or  destroy  a  worse  poison. 
Says  Prof.  Jos.  M.  Smith,  M.D.,  of  the  New  York  Col¬ 
lege  of  Physicians  and  Surgeons  :  “  All  medicines 
which  enter  the  circulation  poison  the  blood ,  in  the 
same  manner  as  do  the  poisons  that  produce  disease.” 

“  The  disease  is  essentially  a  fever ,  and  requires  the 
alterative  and  evacuant  plan,  emetics,  cathartics,  di¬ 
aphoretics,  etc.,”  is  the  teaching  of  another. 

u  The  fever  is  sthenic  f  exclaims  another ;  and  digita¬ 
lis,  antimony,  niter,  and  acetate  of  ammonia  are  pre¬ 
scribed. 

u  The  fever  is  typhoid,”  replies  another ;  and  the  pa¬ 
tient  is  stimulated  through  the  whole  course  of  the  dis¬ 
ease,  and  perhaps  for  months,  if  not  years,  after. 

All  the  books  which  have  thus  far  been  written  on 
diptheria  have  recommended  some  form  or  modifica¬ 
tion  of  drug-medication  ;  and  as  I  am  writing  one 
against  drug-medication,  and  in  favor  of  hygienic 
treatment,  and  as  I  wish  to  turn  the  public  judgment 
as  much  as  possible  against  drug  treatment  of  every 
kind,  I  know  not  how  I  can  better  accomplish  this  ob- 


Drug  Treatment. 


161 


ject  than  by  showing  precisely  what  drug  treatment  is, 
according  to  the  most  approved  authorities,  and  what 
the  testimony  of  the  different  practitioners  is,  respect¬ 
ing  the  effects  of  the  treatment  as  recommended  by 
their  professional  brethren.  If  the  reader  does  not. 
see,  in  this  expose,  ample  reason  for  discarding  all 
drug-medication,  and  relying  on  hygienic  agencies 
alone,  “  neither  could  he  be  convinced  though  one 
should  rise  from  the  dead.”  It  will  at  least  prepare 
him  the  better  to  appreciate  the  rationale  of  hygienic 
medication ;  and  I  think  this  exposition  will  enable  the 
candid  mind  to  understand  the  why  and  wherefore  of 
much  of  the  mortality  of  diptheria,  and  of  many  of  its 
complications  and  sequelae. 

Dr.  Slade,  who  regards  diptheria  as  a  specific  dis¬ 
ease,  propagated  by  infection  and  contagion,  and  be¬ 
longing  to  the  category  of  blood  diseases ,  remarks,  in 
relation  to  the  methods  of  treatment  formerly  in 
vogue : 

“  Like  all  diseases  which  have  prevailed  epidemical¬ 
ly,  and  which  have  appalled  by  their  severity  and  fatal¬ 
ity,  or  perplexed  by  their  novelty,  diptheria  has  been 
subjected  to  a  great  variety  of  treatment.  It  is  only 
within  the  last  four  years  that  anything  like  a  unan¬ 
imity  has  existed  in  the  profession  in  regard  to  this 
important  point.  Hot  to  go  farther  back  than  the 
period  of  Bretonneau’s  memoir  on  this  subject,  we 
shall  find  that  an  activity  of  treatment  prevailed 
which  would  scarcely  coincide  with  the  ideas  of  the 
present  day.” 

HVhat  is  “activity  of  treatment?”  If  this  phrase 
has  any  meaning  at  all,  it  means  killing .  And  we 
shall  all  be  glad  to  know  that  such  treatment  does  not 
coincide  with  the  ideas  of  the  present  day.  But  I  fear 


162 


Diptheria. 


it  is  the  result  of  the  practice  of  the  present  day,  and 
even  of  that  practice  which  Dr.  Slade  recommends. 
Dr.  Slade  continues : 

“  Bleeding,  both  local  and  general,  blisters,  certain 
local  applications  to  the  pharynx,  rapid  mercurializa- 
tion,  formed  the  treatment  in  all  cases.  Mercury,  in 
fact,  was  considered  as  the  sheet-anchor  by  a  great 
majority  of  medical  men.  To  quote  the  words  of  Dr. 
Samuel  Bard :  ‘  But,  although  I  consider  mercury  as 
the  basis  of  the  cure,  especially  in  the  beginning  of  the 
disease,  I  do  not  by  any  means  intend  to  condemn  or 
omit  the  use  of  proper  alexipharmics  and  antiseptics.5 
Although  a  few  practitioners  may  still  make  use  of 
this  therapeutic  agent,  it  is  now  generally  agreed  that 
such  is  the  asthenic  nature  of  the  disease  at  the  present 
day,  that  depletion  is  not  borne  well  in  any  form, 
neither  is  the  action  of  mercury  defensible  either  in 
theory  or  practice.55 

If  depletion  can  not  be  borne  in  diptheria,  it  is  be¬ 
cause  the  patient  sinks  under  it ;  and  if  the  use  of  mer¬ 
cury  is  not  defensible,  it  is  because  it  damages  or  kills 
the  patient.  That  such  are  the  results  of  these  “  ther¬ 
apeutic55  agents,  Dr.  Slade  testifies,  though  in  a  very 
gingerly  manner ;  and  it  is  a  sad  pity  that  the  profes¬ 
sion  can  not  see  that  this  truth  applies  to  all  other  feb¬ 
rile  and  inflammatory  diseases — and  even  to  venereal 
diseases,  for  which  it  is  claimed  to  be  the  “  specific 
remedy55 — as  well  as  to  diptheria.  Says  Dr.  Slade 
again : 

“As  we  are  not  yet  acquainted  with  any  specific 
capable  of  arresting  the  course  of  diptheria,  our  treat¬ 
ment  must  be  directed  simply  to  the  conducting  our 
patient  in  his  progress  through  the  disease.55 

Think,  reader,  seriously,  for  one  moment,  of  the  idea 


Drug  Treatment. 


163 


of  a  patient  being  conducted  through  a  disease  !  More 
frequently  still  we  bear  of  a  disease  “running  its 
course”  through  the  patient.  Is  it  not  about  time  that 
the  profession  settled  the  question,  whether  the  patient 
passes  through  disease  or  disease  passes  through  the 
patient?  But  such  expressions,  it  will  be  claimed, 
are  not  literal  but  figurative.  They  are  literal  non¬ 
sense  and  figurative  foolishness.  They  indicate,  as 
well  as  language  can,  the  “  incoherent  expressions  of 
incoherent  ideas,”  which  constitute  the  chief  burden  of 
medical  literature,  so  far  as  the  nature  of  disease  and 
the  action  of  remedies  are  concerned.  When  medical 
writers  learn  the  simple  truth,  that  disease  is  not  a  thing 
which  runs  through  living  organisms,  nor  which  can  be 
run  through  by  a  person,  they  will  cease  to  employ 
such  senseless  and  unmeaning  language.  And  when 
they  understand  that  disease  is  vital  action  in  relation 
to  things  abnormal,  they  will  see  a  better  way  to  treat 
it  than  by  the  administration  of  drug-medicines. 

Dr.  Slade  objects  to  blisters,  because  their  irritation 
aggravates  the  engorgement  and  cellular  infiltration, 
and  also  because  the  blistered  surface  is  liable  to  put 
on  a  diptheritic  or  sloughy  appearance  ;  and  he  con¬ 
demns  bleeding,  “  except,  perhaps,  in  very  rare  excep¬ 
tional  cases.”  Emetics,  he  thinks,  may  be  advisable 
“  under  certain  circumstances,”  and  when  there  is  a 
tendency  to  croupal  symptoms  ;  and  then  he  recom¬ 
mends  full  doses  of  ij>ecac.  He  condemns  “  anything 
like  purging,”  but  approves  simple  enemas  and  mild 
laxatives. 

“  There  are  occasional  cases  of  diptheria  so  mild  in 
character  that  local  applications  to  the  fauces  may  be 
sufficient ;  but  as  a  general  rule  it  may  be  conceded 
that  the  disease  requires  a  tonic  and  sustaining  treat- 


164: 


Diptheeia. 


ment ;  particularly  is  this  often  the  case  at  a  late  period 
of  the  disease.” 

Can  it  he  possible  that  the  disease  requires  a  tonic 
and  sustaining  treatment  l  So  says  Daniel  Dennison 
Slade,  M.D.,  of  Boston,  Mass. ;  and  Dr.  Slade  received 
a  premium  of  one  hundred  dollars  awarded  by  the 
Trustees  of  the  Fiske  Fund,  at  their  annual  meeting 
held  at  Newport,  It.  I.,  July  11,  1860,  said  Trustees 
consisting  of  James  H.  Eldridge,  M.D.,  of  East  Green¬ 
wich,  Charles  W.  Parsons,  M.D.,  of  Providence,  and 
Henry  D.  Turner,  M.D.,  of  Newport — all  of  which 
facts  are  attested  by  S.  Aug.  Arnold,  M.D.,  of  Provi¬ 
dence,  the  Secretary  of  the  Fiske  Fund — for  the  Essay 
which  contains  this  somewhat  startling  announcement. 
And  it  may  be  pertinent  also  to  remark,  in  this  place, 
that  this  Prize  Essay  which  contains  this  remarkable 
statement,  was  published  in  the  American  Journal  of 
the  Medical  Sciences  for  January,  1861,  from  which  it 
has  been  reprinted  in  book  form  for  consultation  and 
reference. 

Were  it  not  that  we  are  dealing  with  a  Prize  Essay, 
indorsed  by  the  Bhode  Island  Medical  Society,  we 
might  be  disposed  to  criticise  the  idea  and  dispute  the 
propriety  of  sustaining  the  dijotheria  with  tonic  treat¬ 
ment.  If  anything  requires  tonic  and  sustaining 
treatment,  it  seems  to  me  it  is  the  patient,  and  not  the 
disease.  But  as  Dr.  Slade  says  it  is  the  disease  which 
requires,  and  as  the  “  authorities”  are  all  on  his  side,  I 
suppose  we  shall  have  to  submit,  which  I  do  under  the 
protest  that  I  can  not  comprehend  the  matter  at  all. 
And  the  author  has  still  further  complicated  the  mat¬ 
ter,  in  representing  that  the  disease  requires  the  tonic 
and  sustaining  treatment  particularly  at  a  late  period 
of  the  disorder  /  in  other  words,  diptheria  should  be 


Drug-  Treatment. 


165 


sustained  by  tonics  in  a  late  period  of  diptheria  !  Why 
not  let  the  disease  run  down  and  die  if  it  will  ?  I  can 
imagine  no  method  for  sustaining  the  disease  except  to 
add  to  its  causes,  and  that  would  be  feeding  the  dip¬ 
theria  sure  enough  !  But  I  am  of  opinion  that  we  had 
better  feed  the  patient — add  to  his  causes — and  let  the 
diptheria  go. 

But,  after  all,  Dr.  Slade  has  employed  none  but  rec¬ 
ognized  medical  parlance.  There  is  not  an  author  of 
a  text-book  on  The  Practice  of  Medicine  who  does  not 
frequently  use  language  in  the  same  sense,  or  the  same 
nonsense,  and  who  does  not  habitually  confound  causes 
of  diseases,  consequences  of  diseases,  the  actions  of 
disease,  the  disease  itself,  and  the  patient,  hhor  will 
they,  nor  can  they  ever  avoid  this  confusion  worse  con¬ 
founded  until  they  get  a  new  and  a  true  theory  of  the 
nature  of  disease,  and  of  its  relation  to  the  vital  organ¬ 
ism.  Says  Dr.  Slade : 

“  Stimulants  and  nourishment  should  be  commenced 
with  early,  and  persisted  in  systematically.  The 
amount,  of  course,  must  depend  upon  circumstances; 
but  in  order  to  insure  efficiency,  they  should  be  varied, 
should  be  given  in  small  doses  at  regular  and  frequent 
intervals,  and  if  rejected  by  the  stomach  should  be 
given  in  the  form  of  enemata.  So  also  witlq  respect  to 
children,  when  they  are  frightened  and  disturbed  by 
painful  attempts  at  swallowing,  and  absolutely  refuse 
everything,  we  have  the  same  resource:  Injections  of 
beef-tea,  with  brandy  and  quinine,  may  be  employed, 
and  thus  life  may  be  not  unfrequently  sustained,  when 
otherwise  it  would  inevitably  have  been  extinguished.” 

As  it  is  “  life”  now,  and  not  disease  that  is  to  be  sus¬ 
tained,  I  go  for  the  principle,  but  do  not  like  Dr. 
Slade’s  manner  of  applying  it.  I  must  infer  from  his 


166 


Diptheeia. 


medico-alimentary  medley  that  he  is  still  a  little  mud¬ 
dled  as  to  what  he  ought  to  prescribe  for.  Beef-tea  is 
poor  nourishment  for  diptheria  ;  and  brandy  and  qui¬ 
nine  are  wretched  food  for  the  patient.  Beef,  being 
food,  may  contribute  to  the  life  of  the  patient ;  while 
brandy  and  quinine,  being  poisons,  must  inevitably 
add  to  the  causes  of  disease.  In  almost  every  instance 
in  which  we  have  known  a  practitioner  to  get  inextri¬ 
cably  befogged  between  conflicting  theories,  or  to  be¬ 
come  perplexingly  embarrassed  with  “  indications  and 
contra-indications, : ”  or  to  be  grievously  harassed  with 
doubt  whether  he  ought  to  give  one  set  of  remedies  or 
just  the  opposite,  he  has  solved  the  difficulty  by  a 
compromise,  adopting  a  little  of  each  of  the  theories, 
and  mixing  up  some  of  both  kinds  of  remedies.  And 
this  seems  to  have  been  the  case  with  Dr.  Slade. 

“  With  regard  to  the  particular  form  of  tonics,”  says 
Dr.  Slade,  “  there  is  a  variety  of  opinion.  There  are 
some  which,  perhaps,  promise  a  greater  chance  of  suc¬ 
cess  than  others,  among  which  we  may  mention  qui¬ 
nine,  tincture  of  chloride  of  iron,  and  chlorate  of  pot¬ 
ash.  But  as  each  of  these  has  powerful  advocates  in  its 
favor,  we  imagine  that,  provided  the  strength  of  the 
patient  be  sustained,  it  is  of  little  importance  by  which 
of  these  ponies  it  is  accomplished.” 

“Provided?”  But  there’s  the  rub.  If  one  poison 
will  sustain  the  strength  of  the  patient — and  we  ought 
to  be  thankful  to  know  distinctly  that  it  is  the  patient 
and  not  the  disease,  the  “strength  of  the  patient”  that 
should  be  sustained — it  is  not,  of  course,  of  so  very 
much  importance  what  other  poisons  are  administered 
or  withheld,  whether  their  advocates  be  powerful  or 
weak. 

After  indicating  his  preference  for  the  tincture  of 


Drug  Treatment. 


1 61 


sesqui- chloride  of  iron — as  the  best  of  the  many  inter¬ 
nal  remedies  which  have  been  advised — with  chlorate 
of  potash,  chloric  ether,  and  hydrochloric  acid  in  the 
form  of  mixture,  sweetened  with  syrup,  and  given  in 
full  and  frequent  doses,  Dr.  Slade  quotes  approvingly 
from  the  Lancet  the  following  remarkable  passage  : 

“  A  free  use  should  be  made  of  generous  wine,  beef- 
tea,  coffee,  eggs,  in  combination  with  brandy  and  wine, 
milk,  and  whatever  other  form  of  nutriment  the  in¬ 
genuity  of  the  surgeon  or  the  fancy  of  the  patient  can 
suggest.” 

A  more  horrid  jumble  of  dietetic  druggery,  or  med¬ 
icated  food,  can  scarcely  be  imagined;  but  if  surgical 
ingenuity,  constructive  or  destructive,  or  invalid  fancy, 
normal  or  morbid,  can  suggest  anything  else,  by  all 
means  let  the  patient  have  it !  Is  this  the  medical 
science  of  the  nineteenth  century  ?  Is  this  the  healing 
art  of  a.d.  1862  ?  And  is  a  prescription  of  diet  and 
drugs,  separately  or  in  combination,  a  surgical  process. 
to  be  devised  by  the  “  ingenuity  of  the  surgeon?”  It 
is  not  even  a  chemical  combination,  but  a  mechanical 
admixture  of  pathological  and  alimentary  ingredients, 
anti-pharmacologically  compounded,  and  most  unphys- 
iologically  confounded.  Were  not  our  subject  a  grave 
one,  we  should  be  disposed  to  wield  no  weapon  but 
that  of  ridicule  against  such  superlative  nonsense. 

But,  seriously,  we  protest  against  stuffing  the  stomach 
with  anything,  much  less  with  these  incongruous  abom¬ 
inations.  The  patient  can  not  digest  food  of  any  kind 
during  the  acute  stage  of  the  local  inflammation,  nor 
until  the  violence  of  the  fever  has  subsided ;  and  to 
burden  the  system  with  anything  which  it  can  not  use, 
under  the  circumstances,  is  merely  to  nourish  and  sus¬ 
tain  the  disease  by  adding  to  its  causes.  When  the 


168 


Diptiiekia. 


vital  powers  are  wholly  occupied  in  a  life  and- death 
struggle,  as  it  were,  to  expel  impurities  from  the  ma¬ 
chinery  of  life,  or  to  deterge  a  virus  from  the  blood,  they 
can  digest  nothing ;  and  to  gorge  the  digestive  appa¬ 
ratus  with  a  promiscuous  medley  of  slops  and  stimu¬ 
lants,  is  to  sustain  the  disease  and  exhaust  the  vitality. 

I  dwell  on  this  point  with  some  emphasis ;  for  there 
is  no  greater  delusion  in  the  wrorld  than  that  which 
mistakes  stimulation  for  nutrition.  The  ideas  are 
exactly  antagonistical ;  and  yet  the  whole  medical  pro¬ 
fession  has  for  ages,  with  less  than  one  exception  in  a 
thousand,  prescribed  stimulants  to  support  the  vital 
powers,  when  the  digestive  function  wxas  feeble  or  sus¬ 
pended,  as  though  stimulation  was  the  equivalent  of  or 
a  substitute  for  nutrition.  Instead  of  supporting  vital¬ 
ity,  stimulants,  of  all  kinds,  exhaust  it;  they  occasion 
its  preternatural  expenditure,  and  all  such  use  of  vital¬ 
ity  is  abuse •  it  is  waste,  and  nothing  else;  as  is  all 
abnormal  action  under  all  circumstances.  Heed  any 
one  wonder  at  the  grave  complications,  the  numerous 
sequelae,  and  the  many  and  serious  cases  of  paralyzed 
muscles  and  prolonged  convalescence,  in  view  of  such 
methods  of  treating  diptheria,  or  drugging  the  patient  ? 

We  have  now  done  with  the  general  and  leading 
remedies  which  Dr.  Siade  recommends  to  be  adminis¬ 
tered  to  patients  suffering  of  diptheria,  and  we  come 
next  to  the  local  and  auxiliary  measures ;  and  as  the 
Prize  Essay,  of  Dr.  Slade  is  confessedly  “  a  full  and  ac¬ 
curate  resume  of  what  is  known  concerning  a  disease 
which  is  now  attracting  universal  attention,’’  and  is  a 
fair  compendium  of  the  views  and  practices  of  the 
American  medical  profession,  I  propose  to  examine  it 
somewhat  critically  to  the  end. 

“  We  come  now  to  speak  of  the  auxiliary  measures 


Drug  Treatment. 


169 


to  be  adopted  in  the  treatment  of  tins  disease,  and  first, 
of  the  local  applications  to  the  fauces.  The  propriety 
of  these  has  been  called  in  question  by  some  writers, 
on  the  ground  that  the  disease  is  a  constitutional  one, 
and,  therefore,  that  they  can  be  of  no  service.  But  we 
must  answer  to  this,  that  there  can  be  no  more  reason 
why  the  local  remedies  are  not  as  applicable  to  this 
affection  as  in  other  constitutional  diseases,  for  exam¬ 
ple,  as  in  syphilis,  scrofula,  carbuncle,  etc.” 

Dr.  Slade  next  indorses  as  “  excellent”  the  following 
reasons  given  by  Dr.  Bristowe  for  discarding  heroic 
applications  to  the  fauces  : 

“  1.  That  the  throat  affection  is  merely  a  local  evi¬ 
dence  of  a  constitutional  disease,  which  is  unlikely  to 
be  arrested  in  its  progress  by  any  treatment  directed  to 
the  secondary  manifestations  only.  2.  That  the  throat 
affection  rarely  kills,  except  by  involving  organs,  such 
as  the  trachea  and  deeper  tissues  of  the  neck,  which 
are  beyond  the  reach  of  the  possible  influence  of  such 
agents.  3.  That  if  the  theoretical  correctness  even  of 
such  treatment  be  admitted,  the  application  of  reme¬ 
dies  to  the  surface  of  a  thick  false  membrane,  with  the 
hope  that  they  may  affect  the  subjacent  mucous  tissue, 
is  not  only  clumsy,  but,  as  regards  the  object  intended, 
practically  useless ;  and  that  the  prior  forcible  removal 
of  the  membrane  from  the  entire  surface,  in  order  to 
their  efficient  employment,  is  unjustifiable  in  the  early 
stage,  even  if  possible,  and  is  likely  only  to  be  followed 
by  increased  inflammation,  and  production  of  false 
membrane.” 

Nevertheless  Dr.  Slade  is  for  a  compromise.  He 
savs  :  “  While  we  concur  in  the  remarks  of  Dr.  Bris- 
towe  so  far  as  regards  the  forcible  removal  of  the  mem¬ 
brane,  particularly  in  the  early  stages,  the  experience 

8 


170 


Diptheria. 


of  almost  all  medical  men  of  the  present  day  bears 
witness  to  the  efficacy  of  the  application  of  caustics  or 
escharotics  to  the  throat.5’ 

We  think  very  little  of  the  experience  .of  medical 
men,  who,  in  adopting  a  false  theory  of  the  nature  of 
disease,  must  necessarily  interpret  the  effects  of  reme¬ 
dies  by  erroneous  standards.  Experience  informs  us 
what  medical  men  have  done,  not  what  they  should  do. 
And  we  shall  see,  presently,  that  some  practitioners  of 
great  experience  declare  that  caustics  only  aggravate 
the  disease  and  extend  the  local  inflammation ;  they 
give  a  reason,  too,  why  escharotics  should  not  be  em¬ 
ployed  in  any  stage  of  diptheria;  and  I  can  not  help 
having  more  respect  for  one  sound  reason,  one  true 
principle,  one  demonstrated  theory,  than  for  all  the  ex 
perience  of  all  the  medical  men  of  all  the  world  in  all 
the  ages,  so  far  as  that  experience  is  judged  by  the 
false  standard  of  the  prevalent  medical  doctrines.  Dr. 
Blade  continues  : 

“  On  the  other  hand,  some  writers  maintain  that  the 
disease  at  the  outset  is  a  local  one,  which  rapidly 
brings  on  a  general  intoxication.  This  would  be  a 
still  stronger  argument — if  we  granted  this  to  be  true 
— for  these  very  local  remedies,  if  applied  in  season, 
might  prevent  a  further  extension  of  the  disease.” 

Surely  the  profession  is  in  a  most  unfortunate  pre¬ 
dicament — unfortunate  at  least  for  the  patient — with 
regard  to  the  rules  of  practice  by  which  they  should 
be  governed  in  the  treatment  of  diptheria.  In  the 
first  place,  the  authors  do  not  agree  whether  the  dis¬ 
ease  is  general  or  local ;  nor,  if  constitutional,  whether 
general  or  local  remedies  are  to  be  put  most  promi¬ 
nently  forward  in  its  treatment.  But  the  reasoning 
of  Dr.  Bristowe,  that  the  trachea  and  deeper  tis- 


Drug  Treatment. 


171 


sues  of  the  neck  “  are  beyond  the  region  of  the  pos¬ 
sible  influence  of  such  agents,”  I  hold  to  be  entirely 
and  mischievously  fallacious.  Any  poisonous  agent 
in  contact  with  any  part  of  the  living  system,  influ¬ 
ences,  to  some  extent,  every  organ  and  structure. 
Its  presence  invariably  occasions  some  disturbance  in 
the  part  or  organ  to  which  it  is  applied,  and  a  less 
degree  of  disturbance  in  organs  and  structures  more 
remote  ;  just  as  the  presence  of  a  thief  in  the  family 
circle,  or  of  a  serpent  in  a  promiscuous  crowd,  would 
occasion  a  general  commotion  among  all  the  persons 
present,  and  a  greater  consternation  or  resistance 
among  those  in  contact  with  or  nearest  to  the  offend- 
ing  thing.  It  is  true,  the  effect  or  influence  of  a  poison 
on  a  part  distant  from  the  point  of  contact,  is  not  al¬ 
ways  appreciable,  nor  is  its  local  influence  always  ap¬ 
parent  ;  yet,  if  we  understand  the  law  of  constitution 
and  relation  between  dead  and  living  matter,  we  know 
that,  whether  cognizable  to  our  senses  or  not,  some 
effect  must  result,  just  as  we  know  that  when  we  add 
a  drop  of  water  to  the  Croton  Reservoir,  the  bulk  of 
the  whole  mass  of  fluid  is  increased,  although  our  eyes 
can  see  no  difference.  The  constant  dripping  of  the 
soft  water  will  in  time  wear  away  the  solid  rock ;  yet 
our  eyes  could  recognize  no  change  from  day  to  day  ; 
and  so  the  constant  use  of  stimulants,  irritants,  nerv¬ 
ines,  narcotics,  and,  indeed,  of  any  other  drug  or 
poison,  gradually  and  imperceptibly  exhausts  the  life- 
power,  until  the  accumulated  debility  brings  us  to  the 
recognition  of  the  law  of  vitality,  and  the  consequences 
of  abnormal  vital  expenditure. 

It  is  quite  common  for  medical  men  to  say,  when 
their  remedies  have  not  benefited  the  patient,  that 
they  have  had  no  effect  whatever.  This  is  impossible. 


172 


Diptheeia. 


They  do  and  must  occasion  vital  action.  Nothing  can 
be  inert  or  neutral  in  relation  to  the  living  organism. 
It  is  either  useful  or  injurious  ;  and  its  administration 
as  a  medicine,  as  well  as  its  accidental  presence,  must 
and  does  always,  and  under  any  circumstance,  exercise, 
so  to  speak,  an  influence.  Of  the  individual  agents 
employed  as  local  applications,  Dr.  Slade  testifies  very 
dubiously  and  rather  ambiguously  : 

“  There  are  a  multitude  of  substances  which  have 
been  employed  as  local  applications  to  the  fauces, 
all  of  which  have  their  special  advocates.  During 
the  last  four  years,  the  nitrate  of  silver,  either  solid  or 
in  solution,  has  been  perhaps  more  extensively  used 
than  any  other  substance.  This,  when  used  early  in 
the  disease,  seems  in  many  cases  to  check  the  progress 
of  the  exudation ;  yet  it  does  not  answer  the  purpose 
altogether,  and  further  experience  has  somewdiat  di¬ 
minished  confidence  in  it.  Indeed,  in  some  instances 
it  is  a  question  whether  the  free  application  of  this 
caustic  does  not  rather  add  to  the  evil.5’ 

Nitrate  of  silver,  we  are  told,  has  been  more  exten¬ 
sively  employed  than  any  other  caustic,  and  experience 
diminishes  confidence  in  it.  What  are  we  to  do  ?  Dr. 
Slade  has  told  us,  a  little  way  back,  that  “  the  experi¬ 
ence  of  almost  all  medical  men  of  the  present  day 
bears  witness  to  the  efficacy  of  the  application  of  caus¬ 
tics  or  escharotics  to  the  throat.”  The  testimony  is  in 
favor  of  some  cauterizing  agent,  and  against  nitrate  of 
silver.  What,  then,  is  the  proper  article  ?  Dr.  Slade 
solves  the  difficulty  in  his  usual  half-and-half  compro¬ 
mising  manner : 

“  Still,  if  carefully  and  properly  used,  nitrate  of  sil¬ 
ver  in  many  cases  is  undoubtedly  of  benefit.  If  in 
solution,  it  is  to  be  applied  by  means  of  a  probang  or 


Drug-  Treatment. 


173 


brush,  swabbing  over  the  diseased  surface  quickly,  at 
the  same  time  thoroughly.  The  strength  of  the  solu¬ 
tion  should  be  from  30  to  60  grains,  and  perhaps 
higher,  to  the  ounce  of  water,  according  to  circum¬ 
stances.  For  children,  a  full-sized  camel’s  hair  brush 
is  best.  The  child  should  be  placed  on  the  lap  of  an 
attendant,  and  the  head  firmly  fixed.  If  he  will  not 
open  the  mouth,  the  nostrils  should  be  closed  for  a  few 
moments,  and  as  he  opens  the  mouth  for  breath,  the 
jaw  should  be  at  once  depressed,  and  then,  the  tongue 
being  kept  down  by  the  finger,  the  fauces  are  brought 
well  into  view,  and  the  solution  thus  thoroughly  ap¬ 
plied.  The  utmost  gentleness  and  patience  should  be 
exercised;  at  the  same  time,  firmness,  for  upon  the 
effectual  accomplishment  of  this  proceeding  the  suc¬ 
cess  of  the  treatment  will  greatly  depend.  This  should 
be  repeated  every  three  or  four  hours,  so  long  as  it  is 
necessary.” 

“  According  to  circumstances,”  u  and  so  long  as  it  is 
necessary,”  are  rather  loose  and  indefinite  rules  for  the 
application  of  so  potent  an  agent,  especially  when  we 
are  given  to  understand  that  the  profession  is  divided 
on  the  question  whether  it  tends  to  cure  the  disease  or 
to  kill  the  patient ;  and  more  especially  when  our  au¬ 
thor  is  himself  partly  on  both  sides  of  the  question,  and 
partly  between  the  rival  opinions.  Nevertheless,  Dr. 
Slade,  with  commendable  candor,  quotes  a  brief  chap¬ 
ter  of  the  evils  of  cauterization,  from  the  pen  of  F.  A. 
Bulley,  F.  Ik  C.  S.,  and  the  Medical  Times  and  Ga¬ 
zette  for  April,  1859 : 

“  I  have  mentioned  that  I  thought  that  the  indis¬ 
criminate  mopping  of  the  fauces,  as  it  is  called,  with 
solutions  of  nitrate  of  silver,  was  frequently  attended 
with  injurious  results  in  this  disease,  principally,  I 


174 


Diptheeia. 


believe,  for  this  reason,  that,  owing  to  the  struggles  of 
the  little  patient,  it  is  impossible  to  apply  the  caustic 
solution  with  that  precision  which  the  case  absolutely  re¬ 
quires.  Thus,  it  is  applied  to  parts  which  are  entirely 
free  from  disease.  I  have  been  told  of  cases  where 
the  inside  of  the  cheeks  have  been  covered  with  it ; 
in  coughing,  a  portion  of  it  has  been  expelled  upward 
through  the  nose,  corroding  the  susceptible  surface  of 
its  mucous  membrane  ;  and  again,  other  portions  of  it 
have  seemed  to  pass  downward  into  the  pharynx  and 
esophagus ;  and  I  am  not  sure  that,  during  the  convul¬ 
sive  struggling  of  the  patient  in  resistance,  some  of  it 
may  not  also  enter  the  larynx,  where  it  may  possibly 
initiate  those  inflammatory  changes  in  the  mucous 
membrane  of  the  air-passages,  which  are  too  frequent¬ 
ly  the  harbinger  of  death  in  this  disease.” 

To  the  adverse  testimony  of  Dr.  Bulley,  Dr.  Slade 
adds  the  following  pro  and  con: 

“The  nitrate  of  silver  may  also  be  employed  in  the 
solid  form,  bnt  this  we  should  not  advise,  particularly 
in  the  case  of  children.  During  the  struggles  of  the 
little  patient  the  crayon  might  become  broken,  an  ac¬ 
cident  which  has  happened,  and  fragments  fall  into  the 
esophagus  or  larynx,  giving  rise  to  serious  lesions. 
Moreover,  the  nitrate  of  silver  in  this  form  has  the  dis¬ 
advantage  of  creating  a  more  decided  eschar  than  does 
the  solution,  simulating  the  diptheritic  exudation,  and 
thus  hindering  the  perception  of  the  progress  of  the 
disease.” 

Dr.  Slade  regards  the  tincture  of  chloride  of  iron  as 
an  excellent  substitute  for  the  nitrate  of  silver,  and 
commends  hydrochloric  acid  “in  some  cases,”  but 
forgets  to  tell  us  to  what  cases  it  is  adapted.  In  the 
case  of  children,  the  addition  of  honey  to  the  acid  is 


Drug  Treatment. 


175 


recommended.  Hydrochloric  acid  was  a  favorite  top¬ 
ical  application  with  M.  Bretonneau,  who  preferred  to 
employ  the  agent  in  its  full  strength,  at  long  intervals, 
than  to  return  to  less  energetic  applications  more  fre¬ 
quently. 

Dr.  Slade  also  mentions  commendatorially  as  local 
applications,  a  solution  of  the  chloride  of  soda,  chlo¬ 
rate  of  potash,  and  the  combination  of  chlorate  of  pot¬ 
ash  and  hydrochloric  acid  with  the  tincture  of  the 
sesqui-chloride  of  iron,  this  combination  being  espe¬ 
cially  adapted  to  croupal  cases ;  and  the  chlorate  of 
potash,  we  are  informed,  has  “  an  undoubtedly  anti- 
diptheritic  influence,  where  time  exists  to  bring  it 
into  play.” 

This  anti-diseaseical  influence  of  a  remedy  reminds 
me  of  some  of  the  celebrated  preventive  horse-medi¬ 
cines  of  Dr.  Dadd,  the  veterinary  surgeon,  which,  to 
borrow  his  beautifully  philosophical  expression,  opera- 
rate  anti-pathologioally. 

Among  the  numerous  other  applications  to  the  fau¬ 
ces  which  are  employed  and  recommended  by  practi¬ 
tioners,  Dr.  Slade  mentions  strong  solutions  of  sulphate 
of  copper,  chloride  of  sodium,  tannin,  capsicum,  and 
Monsell’s  salt.  With  regard  to  the  virtues  of  Monsell’s 
salt  Dr.  Slade  quotes  the  following  testimony  of  Dr. 
Beardsley,  of  Milford,  Conn. : 

“  Monsell’s  salt  was  found  to  be  the  most  efficacious 
and  valuable  of  all  topical  remedies,  affording  in  some 
instances  decided  relief.  Its  active  astringent  property 
rendered  it  peculiarly  appropriate,  and  well  adapted  to 
obviate  that  relaxed  and  enfeebled  condition  of  the 
throat  which  attends  the  advanced  stage  of  the  dis¬ 
ease.” 

We  have  already  seen  that  fourteen  out  of  Dr, 


176 


Dipthekia. 


Beardsley’s  fifteen  cases  terminated  fatally,  and  that 
the  fifteenth  case  was  probably  saved  by  running  away 
from  the  doctor ;  and  in  view  of  these  facts,  and  of  the 
statement  of  Dr.  Slade  in  relation  to  these  cases,  viz., 
^  “there  was  nothing  peculiar  in  the  treatment,”  the 
opinion  of  Dr.  Beardsley  that  Monsell’s  salt  “  was 
found  to  be  the  most  efficacious  and  valuable  of  all 
topical  remedies,”  affording,  in  some  instances ,  “de¬ 
cided  relief,”  its  astringent  properties  being  “  peculiarly 
appropriate,”  etc.,  must  be  taken  for  what  they  are 
worth.  The  efficacy,  so  far  as  results  were  concerned, 
seems  to  have  been  in  the  wrong  direction. 

In  cases  where  there  is  much  tonsillitis ,  the  inhala¬ 
tion  of  steam,  mucilaginous  gargles,  and  warm  fomen¬ 
tations  are  recommended  ;  and  M.  Boucliat  has  advised 
the  removal  of  the  tonsils  in  the  early  stage  of  the  dis¬ 
ease.  To  this  tonsillitic  ablation  Dr.  Slade  raises  the  fol¬ 
lowing  objections :  “In  the  first  place,  the  exudation  is 
almost  sure  to  re-form  upon  the  cut  surface ;  next,  there 
is  a  great  risk  of  severe  hemorrhage ;  and  finally,  any 
cutting  operation,  however  simple,  had  better  be 
avoided,  if  possible,  especially  upon  young  children, 
and  in  a  disease  so  asthenic  in  its  character.” 

For  the  purpose  of  facilitating  respiration  in  an 
adult,  in  cases  of  great  tumefaction,  the  removal  of  the 
tonsils,  Dr.  Slade  says,  “  might  possibly  be  practiced,” 
by  which  expression  I  presume  he  means,  might  possi¬ 
bly  be  justifiable. 

When  the  nasal  fossae  have  become  implicated, 
various  solutions  and  powders  have  been  recommended 
to  be  employed  by  injection  and  by  insufflation.  MM. 
Bretonneau  and  Trosseau  preferred  alum.  Dr.  Slade 
advises  chloride  of  soda  and  glycerine ;  also  frequent 
injections  of  warm  water  and  soap  as  a  cleansing 


Drug  Treatment. 


177 


process.  Dr.  Slade  adds:  <£  Injections  of  nitrate  of  sil¬ 
ver,  sulphate  of  zinc,  and,  in  fact,  any  solution  which 
is  applicable  for  the  fauces,  will  answer  a  good  purpose 
for  injecting  the  nasal  cavities.55 

All  very  easy  to  write.  But  the  practical  difficulty 
is  to  find  whether  these  things  are  applicable  or  not  to 
the  fauces  ;  and  the  testimony  of  the  authors  we  have 
thus  far  quoted,  leaves  this  matter  decided  both  ways , 
and  this  is  what  we  term  proving  too  much ,  and  thereby 
invalidating  the  evidence. 

Dr.  Slade,  in  conclusion,  gives  us  a  summary  of  the 
arguments  and  authorities  for  and  against  the  opera¬ 
tions  of  tracheotomy  and  tubing  the  larynx ,  which  sub¬ 
jects  I  shall  refer  to  again. 

Having  thus  reviewed  the  whole  theory  and  prac¬ 
tice  of  Dr.  Slade — whose  Prize  Essay  gives  us  the 
substance  of  the  doctrines  and  prescriptions  of  the 
medical  profession  in  relation  to  diptheria — let  us  brief¬ 
ly  glance  at  the  teachings  of  other  authors  and  prac¬ 
titioners.  And  first  we  turn  to  the  latest  author  of  a 
standard  work  on  theory  and  practice  (“  Wood’s  Prac¬ 
tice  of  Medicine55),  which  work  is  a  text-book  in  our 
medical  schools.  Dr.  Wood  does  not  agree  with  Dr. 
Slade,  that  the  disease  is  always  asthenic,  requiring  the 
stimulant  and  tonic  treatment  from  the  first.  On  the 
contrary,  Dr.  Wood  regards  it  as  sometimes  of  the 
opposite  diathesis,  and,  accordingly,  he  recommends 
the  very  opposite  treatment — bleeding,  salts,  etc.  In¬ 
deed,  the  general  plan  of  treatment  recommended  by 
Dr.  Wood  in  his  standard  work,  is  the  very  treat¬ 
ment  which  is  condemned  by  Dr.  Slade  in  his  Prize 
Essay. 

As  an  illustration  of  the  “  unanimity55  which  does 
not  prevail  in  the  medical  profession  respecting  the 

8* 


178 


Diptheeia. 


nature  and  treatment  of  diptheria,  let  us  place  the 
principles  of  medication  advocated  by  these  distin¬ 
guished  authors  in  contrast. 

Says  Dr.  Wood  (vol.  i.,  p.  553):  “In  the  mildest 
cases  little  general  treatment  is  required.  The  patient 
may  take  a  dose  of  sulphate  of  magnesia,  or  some 
other  saline  cathartic,  and  should  avoid  animal  food. 
In  somewhat  severer  cases,  with  moderate  fever,  the 
cathartic  may  be  repeated,  and  antimonials  and  the 
neutral  mixture  administered  at  short  intervals.  When 
the  pulse  is  full  and  strong,  blood  should  be  taken  free¬ 
ly  from  the  arm,  especially  in  adults ;  but  venesection 
does  not  exercise  the  same  controlling  influence  over 
this  as  over  the  common  inflammation ;  at  least,  it 
does  not  obviate  the  tendency  to  the  plastic  affusion  ; 
and,  in  some  instances,  in  consequence  of  the  feeble¬ 
ness  of  the  system,  is  not  well  borne.  It  is  generally 
quite  inapplicable  to  those  cases  which  occur  epidemi¬ 
cally,  or  in  which  a  dark  hue  or  fetid  odor  of  the  exu¬ 
dation  indicates  a  depraved  state  of  the  blood.  When 
the  symptoms  are  threatening,  either  from  the  general 
condition  of  the  system  or  the  disposition  in  the  local 
disease  to  enter  the  respiratory  passages,  calomel  should 
be  resorted  to.  Under  these  circumstances,  no  general 
means  of  cure  is  so  effectual  as  the  establishment  of 
the  mercurial  influence.  If  the  patches  should  have 
reached  the  glottis,  or  be  extended  toward  it,  a  full 
purgative  dose  of  calomel  should  be  given,  and  the 
medicine  afterward  continued  in  doses  of  from  half  a 
grain  to  two  grains,  every  hour  or  two,  until  the  mouth 
is  affected  or  the  disease  relieved.  Even  young  chil¬ 
dren,  under  these  circumstances,  bear  calomel  well 
in  the  quantity  mentioned.  Should  it  irritate  the 
stomach  and  bowels  very  much,  the  dose  may  be  dn 


Drug-  Treatment.  119 

minished,  or  the  mercurial  pill,  and  frictions  with 
mercurial  ointment,  substituted.” 

If  there  is  anything  loose,  slip-shod,  vague,  indefi¬ 
nite,  or  ambiguous  in  the  Prize  Essay  of  Dr.  Slade,  it 
is  equaled,  if  not  exceeded,  in  the  “  Practice  of  Medi¬ 
cine”  of  Dr.  Wood,  while  on  the  main  points  of  treat¬ 
ment,  these  authors  are  diametrically  opposed  to  each 
other. 

Dr.  "Wood  not  only  recommends  the  depleting  plan 
in  many  cases,  but  assures  us  that  it  is  the  very  best. 
He  says  :  “  Ho  general  means  of  cure  is  so  effectual  as 
the  establishment  of  the  mercurial  influence.” 

Dr.  Slade  says  :  “  The  action  of  mercury  is  defensi¬ 
ble  neither  in  theory  nor  practice.” 

Dr.  Wood  says  :  “  When  the  pulse  is  full  and  strong, 
blood  should  be  taken  freely  from  the  arm.” 

Dr.  Slade  says  :  “  Depletion  is  not  borne  well  in 
any  form.” 

Dr.  Wood  prescribes  “  full  purgative  doses  of  cal¬ 
omel.” 

Dr.  Slade  replies,  u  Anything  like  purgatives  should 
be  sedulously  avoided.” 

Dr.  Wood  recommends  the  most  depleting  and  de¬ 
bilitating  drugs  of  the  materia  medica — neutral  salts 
and  antimony. 

Dr.  Slade  insists  that  such  practice  is  always  injuri¬ 
ous. 

Well,  what  is  the  young  practitioner,  or  the  old  one, 
to  do,  when  he  goes  forth  to  combat  diptheria,  with 
these  high  authorities  in  his  hands  ?  Probably  he,  too, 
will  compromise,  and  adopt  partly  the  practice  of  each, 
and  so  do  with  one  hand  and  undo  with  the  other. 

Dr.  Wood  recommends,  as  external  applications  to 
the  throat,  leeches,  rubefacients,  and  blisters ;  and,  in 


180 


Diptheeia. 


relation  to  the  internal  local  applications,  he  advises : 
“  By  far  the  most  important  remedies  are  those  ad¬ 
dressed  immediately  to  the  part  affected.  By  these  the 
peculiar  character  of  the  inflammation,  upon  which  its 
danger  chiefly  depends,  may  he  changed  ;  and  if  the  dis¬ 
ease  has  not  already  reached  the  larynx,  its  progress 
may  he  arrested.  In  the  slighter  forms,  a  solution  of 
sulphate  of  zinc,  containing  fifteen  or  twenty  grains  of 
the  salt  in  a  fluid  ounce,  applied  daily  or  twice  a  day 
to  the  pseudo-membranous  patches,  will  be  found  suffi¬ 
cient.  When  a  stronger  impression  is  required,  caustic 
substances  must  be  employed.  Of  these  the  best  is 
nitrate  of  silver,  which  may  be  applied  either  in  the 
solid  state,  or  dissolved  in  six  or  eight  parts  of  water. 
Muriatic  acid  is  highly  recommended  by  some  writers, 
and  in  the  worst  cases  is  used  undiluted.  In  those  of 
slower  progress,  it  may  be  diluted  more  or  less  accord¬ 
ing  to  the  impression  desired.  Alum  is  another  very 
efficient  application.  It  is  used  in  saturated  solution, 
or  in  the  form  of  a  very  fine  powder,  wdiich  is  applied 
directly  to  the  part  by  blowing  it  through  a  tube 
adapted  to  the  purpose.  These  substances  should  be 
allowed  to  come  in  contact  as  little  as  possible  with 
any  other  part  of  the  surface  than  those  covered  with 
the  exudation.  The  liquids  may  be  applied  by  means 
of  a  large  camel’s  hair  pencil,  or  of  a  piece  of  sponge 
or  soft  linen  attached  to  the  end  of  a  stick.  In  the 
intervals  between  the  caustic  applications,  mucilagin¬ 
ous  gargles,  sweetened  or  not  with  honey  of  roses,  may 
be  beneficially  used.  A  gargle  made  of  a  fluid  dram 
of  chlorinated  soda  and  four  fluid  ounces  of  water,  is 
recommended  in  cases  attended  with  fetid  discharge. 

“  Howard’s  calomel,  applied  to  the  diseased  surface 
by  means  of  a  tube,  was  advised  by  Bretonneau  ;  but 


Drug  Treatment. 


181 


its  chief  advantages  are  probably  derived,  from  the 
portion  of  it  which  may  be  swallowed.  When  the 
disease  enters  the  nasal  passages,  the  solution  of  nitrate 
of  silver  may  be  injected  up  the  nostrils.” 

In  an  article  published  in  the  Medical  Times  and 
Gazette ,  of  Sept.  3,  1859,  by  Dr.  J.  S.  Bristowe,  of 
Southwark,  the  author  is  entirely  opposed  to  the  prac¬ 
tice  so  confidently  advised  by  Dr.  Wood.  He  says  : 

“  An  important  question  is  that  having  reference  to 
the  mode  of  treatment  of  the  affection  of  the  throat ; 
and  I  may  here  state,  as  may  have  been  inferred  from 
the  perusal  of  my  cases,  that  I,  for  one,  disapprove  of 
the  application  to  the  diseased  surface  of  strong  caus¬ 
tics  and  escharotics,  and  should  prefer  the  employment 
in  all  cases  of  mild  detergent  gargles,  or  of  warm  milk, 
and  such  like  bland  and  soothing  fluids.” 

We  have  already  quoted  the  reasons  which  have  led 
Dr.  Bristowe  to  discard  heroic  applications. 

Dr.  C.  Swaby  Smith,  of  Barbage,  Wiltshire,  gives 
his  experience  in  the  London  Lancet  of  Sept.  10, 1859  : 
“  I  have  tried  many  modes  of  treatment,  and  so  far 
with  very  good  results  ;  but  the  one  that  I  have  most 
faith  in  is  one  that  I  would  advise  those  who  have  not 
used  it,  at  any  rate  just  to  give  it  a  trial.  On  first 
seeing  my  patient,  I  apply  a  strong  solution  of  chlo¬ 
rinated  soda  to  the  fauces  ;  and  follow  up  my  treat¬ 
ment  by  ordering  a  sinapism  to  the  throat ;  a  gargle, 
composed  of  solution  of  chlorinated  soda,  two  ounces ; 
tincture  of  myrrh,  two  drams ;  water,  six  ounces ;  to 
be  used  every  half  hour  ;  and  in  cases  where  the  chil¬ 
dren  are  too  young  to  gargle,  I  order  the  throat  to  be 
frequently  washed  with  the  same  mixture  by  means  of 
a  piece  of  sponge.  Internally,  I  give  to  an  adult  (of 
course  varying  the  dose  according  to  my  patient’s  age), 


I 


182 


Diptheria. 


chlorate  of  potash,  two  drams  ;  diluted  nitric  acid,  three 
drams ;  solution  of  cinchona  (Battley’s),  one  dram  ; 
water,  to  six  ounces ;  the  sixth  part  to  be  taken  every 
two  hours.  And  in  cases  where  there  is  much  pain  in 
the  limbs,  I  generally  add  a  few  minims  of  tincture  of 
colchicum  ;  which  addition  has  proved  decidedly  ad 
vantageous  ;  the  diet  to  consist  of  strong  beef-tea,  port 
wine,  and,  in  short,  all  the  nourishment  the  patient  can 
take.” 

Dr.  Smith  is,  of  course,  a  believer  in  the  absurd 
“  respiratory  food”  theory  of  Liebig  and  others,  or  he 
wrould  not  conjoin  an  alcoholic  stimulant  with  a  so- 
lution  of  beef,  under  the  head  of  diet.  But  I  protest 
against  his  rule  regulating  the  quantity  of  diet — “  all 
the  patient  can  take.”  The  patient  might  be  able  to 
take  a  gallon  a  day,  when  he  could  not  digest  more 
than  a  pint.  The  rule  for  the  administration  of  food 
should  be,  in  all  cases  of  diptheria,  whatever  the  patient 
can  use.  Food  is  only  beneficial  as  it  is  assimilated, 
not  according  to  the  quantity  swallowed. 

Dr.  Smith’s  concluding  remark  casts  a  shade  of  sus¬ 
picion  over  the  supposed  beneficial  effects  of  his  pun¬ 
gent  gargles,  etc.  “  Although  these  means  are  un¬ 
doubtedly  useful  in  decided  cases  of  malignant  sore 
throat,  they  are  far  too  active  to  be  resorted  to  in 
simple  cases,  as  they  would  only  tend  to  aggravate  the 
symptoms.” 

My  own  explanation  is  this  :  These  “  active  means,” 
or  strong  applications,  which  aggravate  the  symptoms 
in  mild  cases,  do  not  benefit  the  malignant  cases  ;  but 
because  of  the  less  degree  of  vital  resistance  to  the 
drugs  in  the  malignant  cases  they  seem  to  be  well 
borne,  and  the  practitioner  is  deluded  into  the  notion 
that  they  are  useful. 


Drug  Treatment. 


183 


Prof.  Clark  condemns,  in  the  strongest  terms,  the 
depleting  and  cauterizing  treatment  so  strongly  recom¬ 
mended  by  Prof.  Wood  and  others,  and  relies  almost 
entirely  on  the  stimulating  plan  ;  and  his  summary  of 
the  conflicting  opinions  of  various  authors  and  prac¬ 
titioners,  if  it  does  not  prove  how  diptheria  ought  to  be 
treated,  at  least  shows  how  little  reliance  can  be  placed 
on  medical  experience  and  testimony.  I  quote  entire 
what  he  says  of  the  treatment  of  this  disease  in  con¬ 
cluding  his  lectures  on  the  subject : 

“  There  is  no  established  treatment  for  diptheria. 
In  saying  this,  I  speak  of  the  whole  treatment,  for  I 
think  one  rule  in  the  management  of  diptheria  is  as 
well  established  and  as  generally  insisted  on  as  any  in 
medicine — that  is,  to  sustain  the  patient’s  strength  by 
food,  tonics,  and  often  by  stimulants,  during  the  whole 
course  of  the  disease,  and  to  do  this  in  the  face  of  every 
difficulty.  This  rule  is  not  an  arbitrary  one,  but  is  the 
result  of  an  extended  and  almost  uniform  experience 
in  Europe  and  in  this  country.  Many  physicians,  in 
their  early  acquaintance  with  the  disease,  have  adopted 
the  opposite  plan,  but  have  found  that  bleeding  and 
depressing  agents  generally  could  not  be  safely  per¬ 
sisted  in.  Bretonneau,  in  his  second  memoir,  read 
before  the  Academy  of  Medicine  in  Paris  in  1821,  is 
very  explicit  on  this  point.  He  says  (p.  4)  :  c  With 
regard  to  Epidemic  Croup ,  I  am  compelled  to  declare, 
contrary  to  the  generally  received  principle,  that 
abstraction  of  blood  has  appeared  to  me  hurtful,  and  to 
accelerate  the  propagation  of  diptheritic  inflammation. 
Emetics  and  blisters  have  been  used  without  relief; 
and  I  can  assert  that  these  means  have  not  been  omit¬ 
ted  in  the  greater  number  of  patients  who  have  died.’ 

‘  I  have  not  abandoned  it  [depletion]  without  hesita- 


184 


Diptiieeia. 


tion  (though  it  was  condemned  by  the  physicians  of 
the  seventeenth  century) ;  I  have  been  compelled, 
nevertheless,  to  yield  to  evidence,  seeing  so  frequently 
the  opposite  of  that  which  I  had  hoped.  I  am  certain 
that  the  symptoms  of  croup  [tracheal  diptlieria],  so  far 
from  being  retarded,  have  several  times  manifested 
themselves  immediately  after  the  application  of  leeches, 
applied  for  the  purpose  of  preventing  this  fatal  disease, 
the  fear  of  which  had  been  excited  by  a  very  slight 
sore  throat.  I  am  now  astonished  that  I  did  not  sooner 
understand  that  sinapisms,  pediluvia,  and  irritant  in¬ 
jections  were  measures  which  were  not  appropriate  to 
the  nature  of  the  disease,  and  were  without  proportion 
to  its  severity.’ 

“  Dr.  Turner,  of  Petersburgh,  Ya.,  has  given  us  his 
experience  with  this  plan  of  treatment  (Am.  Med. 
Times ,  Dec.  8,  1860) :  4  Depletants,  mercurial  alter¬ 
atives,  leeches,  blisters,  caustics,  and  common  sage 
gargle,  constituted  my  treatment  when  I  first  encount¬ 
ered  diptlieria.’  ‘Those  patients  in  whose  treatment 
I  employed  mercury  and  local  depletants  fared  the 
worst.’  4  I  soon  determined  that  the  disease  was  ulti¬ 
mately  asthenic ,  and  from  this  fact  I  derived  the  basis 
of  what  I  consider  sound  treatment.’  In  this  experi¬ 
ence  of  M.  Bretonneau  and  Dr.  Turner  you  have  an 
account  of  what  has  occurred  in  the  observation  of 
many  a  sound  practitioner,  and  of  what  will  happen  to 
you,  I  doubt  not,  unless  you  begin  where  such  men 
end,  in  an  entire  abstinence  from  depletory  measures, 
whether  general  or  local.  You  have  but  little  tempta¬ 
tion  from  the  examples  of  American  physicians  to  ab¬ 
stract  blood,  because  we  had  been  apprised  of  what  our 
European  brethren  had  learned  about  it,  long  before 
the  disease  reached  us.  But  knowing  what  power  is 


Dkug  Treatment. 


185 


ascribed  to  blood-letting  in  the  management  of  inflam¬ 
mations,  you  would  be  almost  forced  to  a  trial  of  it 
unless  you  are  informed  how  worse  than  useless  it  has 
been  found  by  those  who  have  preceded  you.  We 
may  say,  then,  that  general  sanguineous  depletion  is 
forbidden  in  diptheria,  and  if  local  bleeding  is  ever 
admissible  it  is  only  in  exceptional  cases.  I  will 
give  you  one  quotation  more  in  support  of  this  state¬ 
ment  from  one  of  the  high  authorities  on  this  disease. 
Trosseau  (Mems.,  p.  241)  says  :  4  If  diptherite  did  not 
differ  from  simple  inflammations  in  its  form,  its  prog¬ 
ress,  its  dangers,  and,  in  a  word,  in  numerous  charac¬ 
ters  which  make  it  altogether  a  special  disease,  it 
might  be  supposed  that  antiphlogistic  treatment  would 
be  serviceable ;  but  we  may  conceive,  d  priori,  that 
blood-letting  and  emollients  would  have  no  favorable 
influence,  and  experience  has  confirmed  what  analogy 
had  led  us  to  surmise.  It  is  in  vain  to  attempt  to  cure 
diptherite  by  means  of  the  antiphlogistic  regimen. 
The  inflammatory  complications  may  be  subdued,  and 
yet  the  disease  remains  without  losing  any  of  its  malig¬ 
nity. J  If  we  can  not  inherit  the  wisdom  of  those  who 
precede  us,  we  can  at  least  profit  by  their  learning. 
It  is  for  that  reason  I  have  taken  time  to  place  this 
important  point  fully  before  you. 

“  Diptheria  is  not  a  ‘  self-limited  disease,5  in  the 
sense  in  which  scarlet  fever,  measles,  and  small-pox 
are  said  to  be  self -limited,  yet  it  has  a  duration,  vary¬ 
ing  much  in  different  cases,  but  which  rarely  exceeds 
twenty  days  for  the  membranous  and  most  dangerous 
period.  If  death  does  not  occur  in  three,  five,  seven, 
ten,  or  twenty  days  in  the  different  varieties  and  forms 
of  the  disease,  we  look  for  recovery.  If  we  can  sustain 
our  patient  through  these  trying  periods,  however 


186 


Diptheria. 


varying,  we  Iiave  done  mnch  to  insure  his  recovery. 
The  virulence  of  the  disease  has  exhausted  itself,  or  at 
least  its  power  to  destroy  is  greatly  diminished. 
What  an  eminent  medical  writer  has  said  of  typhus,  can, 
I  think,  with  equal  truth  be  asserted  of  the  constitutional 
management  of  diptlieria  :  ‘  Our  treatment  can  only  be 
of  benefit  in  an  indirect  manner,  that  is,  in  concert 
with  the  salutary  efforts  of  the  vital  powers.’  Exclud¬ 
ing,  for  the  present,  considerations  relating  to  local 
applications,  I  may  go  further  and  say  of  this  disease 
what  Dr.  Stokes  says  of  fever:  ‘¥e  can  not  cure 
fever.  dSTo  man  ever  cured  fever.  It  will  often  cure 
itself.  *  *  *  We  prevent  dying  of  exhaustion  by 

food,  by  the  use  of  stimulants  and  tonics.  *  *  * 

We  seek  to  preserve  the  patient  at  the  least  expense  to 
his  constitution  up  to  the  time  when,  by  natural  laws, 
the  disease  will  spontaneously  subside.’  Here  for 
c  fever,’  read  diptlieria  ;  transpose  the  words  £  stimu¬ 
lants  and  tonics,’  so  as  to  give  the  higher  position  to 
the  latter ;  then,  even  without  reservation  in  favor  of 
local  applications,  I  believe  you  have  found,  the  great 
fundamental  fact  in  the  treatment  of  diptheria.  I  do 
not  wish  to  say,  however,  that  the  rigid  enforcement 
of  this  important  rule  for  twenty  days  will  always  be 
sufficient,  or  to  say  that  in  every  case  the  dangers  are 
all  passed  in  that  time.  I  have  known  the  death  of  a 
child  to  occur  thirty  days  after  the  first  appearance  of 
the  membrane  in  the  throa,t,  and  fully  three  weeks 
after  the  exudation  in  the  larynx  and  trachea  had  been 
fully  cleared  away.  Yet  this  I  believe  is  but  one  case 
in  a  hundred.  In  general,  among  the  very  worst  cases, 
those  who  have  passed  the  dangers  of  the  first  three 
weeks  recover.  But  the  rule  of  treatment  is  applic¬ 
able  with  modifications  to  the  cachexia  which  often 


Drug  Treatment. 


187 


follows  tlie  bad  cases,  and  to  tlie  paralytic  affections 
which,  though  they  are  but  little  dangerous  to  life,  are 
prolonged  for  weeks  and  sometimes  for  months.  Hay¬ 
ing  impressed,  as  I  hope,  these  leading  doctrines  upon 
your  minds,  that  blood-letting,  both  general  and  local, 
has  been  tried  in  vain  ;  that  active  cathartics  do  no 
good  ;  that  emetics  are  worse  than  useless,  except  for 
a  special  purpose  to  be  mentioned  by-and-by  ;  that 
revulsives  can  accomplish  nothing  advantageous  ;  in 
a  word,  that  debilitating  treatment  but  plays  into  the 
hands  of  the  disease,  if  I  may  be  pardoned  the  expres¬ 
sion  ;  and  that  all  perturbating  general  treatment  is 
forbidden  ;  but  that  food,  tonics,  sleep,  and  stimulants 
(when  needed)  are  the  true  antagonistics  of  diptheria — ■ 
we  will  now  try  to  appreciate  the  value  of  the  local 
treatment,  and  determine,  if  we  can,  whether  we  pos¬ 
sess  any  agents  which  have  power  to  prevent  or  con¬ 
trol  its  justly  dreaded  local  manifestations. 

u  Here,  if  I  yield  to  my  own  convictions,  I  must  say 
we  pass  from  the  certain  to  the  doubtful.  It  is  with 
reference  to  these  local  applications  that  we  are  com¬ 
pelled  to  say  that  diptheria  has  no  established  treat¬ 
ment.  If  we  ask  whether  nitrate  of  silver,  muriatic 
acid,  or  any  other  caustic  can  stop  the  progress  of  this 
membranous  disease  of  the  throat,  we  shall  obtain  con¬ 
tradictory  answers.  Bretonneau  answers,  yes — a  thou¬ 
sand  times  yes.  Trosseau  answers,  yes ;  Guersant 
answers,  yes.  Indeed,  there  is  a  confidence  in  the 
power  of  these  agents  among  the  French  physicians, 
whose  opinions  are  best  known  to  us,  that  is  all  but 
overwhelming.  There  is  a  persuasion  in  their  eloquent 
praises  and  reiterated  assurances  that  has  forced  me  tc 
doubt  my  own  experience  ;  and  when  disappointed  in 
the  effects  of  these  agents,  to  return  to  them  again  and 


1S8 


Diptheria. 


again  in  the  hope  that,  by  a  closer  imitation  of  their 
methods,  I  might  participate  in  their  triumphs. 

“  Among  our  own  physicians  I  know  some  whose 
faith  in  the  saving  virtues  of  a  timely  and  efficient  ap¬ 
plication  of  these  substances  is  not  dimmed  by  a  single 
doubt.  I  have  a  friend,  judicious  and  observiug,  who 
can  not  convince  himself  that  the  throat  membrane 
can  ever  resist  the  free  application  of  solid  nitrate  of 
silver,  or  a  solution  of  it,  one  hundred  and  twenty 
grains  to  the  ounce  of  water,  when  it  is  used  early  and 
often.  Dr.  Woodward,  of  Brandon,  Vermont,  believes 
that  he  and  his  friend  Dr.  O’Dys  owe  a  portion  of 
their  success  (sixty  cases  without  a  single  death)  to  the 
early  use  of  this  agent.  This,  and  alterative  doses  of 
mercurials,  were  their  main  reliance  ;  and  he  seems  to 
suppose  that  if  the  disease,  which  was  so  fatal  in  a 
neighboring  town,  had  been  treated  in  the  same  way, 
the  results  would  have  been  more  favorable.  On  the 
other  hand,  while  the  English  physicians  generally  are 
far  behind  the  French  in  their  praise  of  caustic  appli¬ 
cations,  many,  like  Grreenhow,  object  to  them  alto¬ 
gether,  except  in  particular  conditions.  Greenhow’s 
language  is  worth  quoting  :  4  Local  treatment  applied 
to  the  throat  internally  has  been  almost  universally 
adopted  in  the  treatment  of  diptheria  ;  and,  though  I 
by  no  means  deny  its  value  when  judiciously  em¬ 
ployed,  I  am  sure  much  mischief  has  been  produced 
by  its  indiscriminate  use,  etc.  *  *  *  Observing 

that  the  removal  of  the  exudation,  and  the  application 
of  remedies  to  the  subjacent  surface,  neither  shortened 
the  duration  nor  sensibly  modified  the  progress  of  the 
complaint,  but  that  the  false  membrane  rarely  failed 
to  be  renewed  in  a  few  hours,  I  very  soon  discontinued 
this  rough  local  medication.5  When,  however,  the  exu* 


DiitJG  Treatment. 


189 


dation  is  all  within  sight,  and  the  surrounding  parts 
are  healthy,  he  thinks  it  proper  to  apply  solid  nitrate 
of  silver,  or  nitric  or  muriatic  acid,  for  he  says  :  6  it  is 
just  possible  in  such  cases  that  this  treatment  might 
check  the  progress  of  the  complaint,  and  lead  to  a 
rapid  recovery.’  (Diptheria,  pp.  263-4-5.)  Dr.  Tur¬ 
ner,  of  Virginia,  referring  to  similar  applications 
( American  Medical  Times ,  Dec.  18,  1860),  says:  ‘I 
studiously  avoid  probangs ;  I  look  upon  them  as  in¬ 
struments  of  torture  and  death.  I  know  I  have  seen 
cases  that  died  from  the  constant  mopping  to  which 
the  throat  was  subjected.’  Dr.  Metcalfe,  of  this  city, 
says  of  the  application  of  nitrate  of  silver  to  the 
throat  (. American  Medical  Times ,  Aug.  25,  1860),  that 
he  can  not  say  he  has  derived  any  benefit  from  it.  In¬ 
deed,  in  my  intercourse  with  the  physicians  of  this 
city,  I  meet  but  few  who  have  not  tried  it,  and  disap¬ 
pointed  in  its  promised  benefits,  have  abandoned  it. 
My  own  observation  has  taught  me  that  the  false 
membrane  will  not  fall  off  by  the  mere  application  of 
nitrate  of  silver,  either  on  the  exudation  or  on  the  sur¬ 
rounding  parts,  without  the  use  of  some  mechanical 
force ;  and  that  its  application  to  tissues,  after  forced 
or  spontaneous  removal,  will  not  prevent  the  reproduc¬ 
tion  of  the  exudation,  at  least  in  numbers  of  instances. 
I  have  seen  the  membrane  appear  when  it  was  not 
looked  for,  in  the  course  of  scarlet  fever  for  example, 
and  where  the  nitrate  of  silver  had  been  systematically 
applied  for  what  appeared  to  be  a  different  kind  of 
sore  throat.  Yet,  in  these  cases,  it  has  sometimes  fol¬ 
lowed  upon  the  very  heels  of  that  medication.  Such 
facts  as  these,  however,  do  not  prove  that  the  applica¬ 
tion  of  the  nitrate  of  silver  is  useless.  They  destroy 
our  faith  in  its  unfailing  virtues,  and  fairly  raise  the 


190 


Dipthekia. 


question,  whether  this  kind  of  treatment  is  useless, 
cruel,  and  to  be  abandoned  ;  or  if  failing  in  many,  it 
really  saves  the  lives  of  some.  This  doubt  I  can  not 
solve  for  you.  I  can  only  say  that  my  faith  in  the 
curative  powers  of  all  caustic  applications  is  greatly 
shaken.  But  they  are  proper  applications  so  long  as 
there  is  any  ground  left  for  faith  in  them.  That  you 
may  know  how  to  use  them,  not  from  a  doubter  like 
myself,  but  from  one  whose  confidence  in  the  nitrate 
of  silver,  as  the  representative,  and  the  best  of  them 
all,  illuminates  almost  every  page  of  ample  memoirs, 
I  shall  quote  again  from  Bretonneau.  In  his  earlier 
memoirs,  he  recommends  hydrochloric  acid,  diluted 
with  three  parts  of  honey  ;  he  even  used  this  acid  con¬ 
centrated  and  pure.  Powdered  alum  was  also  a  fre¬ 
quent  application.  In  his  fifth  memoir,  he  modifies 
his  former  statements  (p.  192  and  onward):  ‘Of  the 
local  applications  employed  to  modify  the  Egyptian 
ulcerations,  there  are  none  so  painful  as  alum  and  hy¬ 
drochloric  acid,  while  a  solution  of  nitrate  of  silver  is 
less  painful  and  more  efficacious ;’  and  he  gives  the 
credit  of  first  suggesting  it  to  Dr.  Mackenzie,  of  Glas¬ 
gow.  4  On  the  first  day  of  the  appearance  of  the 
Egyptian  chancre  (meaning  here  tonsillar  diptheria)  a 
radical  cure  can  be  obtained  in  forty-eight  hours.’  4  It 
is  sufficient  to  employ  on  the  first  day  two  local  appli¬ 
cations — one  in  the  morning  and  one  in  the  evening ; 
and  to  repeat  the  proceeding  the  next  day.’  The 
sponge  used  for  the  application  should  be  moistened, 
not  soaked.  When  the  disease  has  passed  into  the  tra¬ 
chea,  the  sponge  should  be  applied  with  gentle  press¬ 
ure  to  the  opening  of  the  larynx,  the  epiglottis  being 
held  pitilessly  forward.  4  After  a  few  minutes’  respite, 
the  same  proceeding  must  be  repeated  in  all  its  details, 


Drug  Treatment. 


191 


the  sponge  having  been  washed,  wiped,  and  dried,  by 
pressure  of  a  very  dry  piece  of  linen.’  He  relates  the 
case  of  a  child  three  years  old,  in  which  a  membrane 
that  was  raised  was  a  cast  of  the  larynx,  and  its  broken 
bronchial  extremity  had  an  alarming  thickness,  such 
as  to  forbid  tracheotomy,  but  in  which  four  applica¬ 
tions  in  this  way,  each  repeated  (eight  each  day),  were 
practiced.  4  From  the  fourth  day  all  anxiety  ceased.’ 
4 1  affirm  that  without  error  in  calculation,  a  solution 
of  thirty-two  grammes  (four  hundred  and  ninety-four 
grains)  of  the  crystallized  nitrate  of  silver  wras  com¬ 
pletely  employed  in  this  horrible  treatment.’  Two 
thirds  at  most  being  wasted  ;  4  yet  the  rest  was  in 
great  measure  mingled  with  the  mucous  matter  drawn 
in  at  the  time  of  the  cauterizations.’  The  linen  washed 
and  dried  in  the  sun  showed,  by  the  black  spots  upon 
it,  that  unusual  quantities  of  the  salt  had  been  swal¬ 
lowed. 

44  When  the  disease  is  detected  in  the  nostrils,  he  ad¬ 
vises  to  inject  a  solution  of  nitrate  of  silver  with  a 
padded  syringe;  and  to  inject  both  nostrils,  especially 
if  there  is  the  least  swelling  of  the  neck  glands  on  the 
two  sides.  Bretonneau  does  not  inform  us  regarding 
the  strength  of  the  solution  which  he  prefers,  but  the 
common  practice  is  to  make  it  forty  to  one  hundred 
and  twenty  grains  to  the  ounce  of  water.” 

Dr.  Winne  gives  us  the  most  promiscuous  jumble  of 
drug-medication  extant,  and  as  the  best  specimen  of  its 
kind  I  put  it  on  record.  If  it  does  not  convince  the 
reader  that  the  jarevalent  practice  in  diptheria  is  a 
series  of  blind  experiments  on  the  vitality  of  the  pa¬ 
tients,  I  know  of  no  evidence  that  will  be  likely  to 
do  so. 

44  The  local  treatment  consists  chiefly  in  the  applica- 


192 


Diptheria. 


lion  of  caustic  and  astringent  substances,  in  one  form 
or  another,  to  the  affected  part.  Of  these,  the  most 
usual  are  nitrate  of  silver,  either  solid  or  in  solution, 
powdered  alum,  chloride  of  lime,  chloride  of  soda,  ses- 
qui-chloride  of  iron,  and  hydrochloric  acid. 

“  M.  Bretonneau  almost  invariably  employed  the  last 
of  these  remedies  as  a  local  application  in  his  own 
practice,  with  the  most  marked  success.  The  hydro¬ 
chloric  acid  may  be  employed  very  nearly  of  the 
strength  of  the  dilute  acid'  of  the  shops,  or  consider¬ 
ably  reduced  in  strength — dependent  upon  the  severity 
or  mildness  of  the  attack.  The  best  method  of  apply¬ 
ing  it  is  to  moisten  a  small  sponge  attached  to  a  pro¬ 
bang  or  a  camel’s  hair  pencil  with  the  fluid,  and  while 
depressing  the  tongue  with  the  left  hand,  to  carry  the 
brush  forward  with  the  right,  until  the  fauces  are 
reached,  when  those  parts  of  the  tonsils,  uvula,  or  soft 
palate  on  which  the  membranous  deposit  appears,  may 
be  moistened  with  the  fluid,  and  the  instrument  with¬ 
drawn.  The  hydrochloric  acid  should  be  applied  not 
only  to  the  membranous  surface,  but  to  the  parts  im¬ 
mediately  surrounding  it,  by  which  means  the  spread 
of  the  membrane  is  often  arrested.  The  application 
should  be  renewed  several  times  a  day.  Care,  how¬ 
ever,  must  be  taken  not  to  apply  it  of  too  great 
strength,  or  too  often  at  the  onset  of  the  disease,  espe¬ 
cially  if  the  symptoms  are  not  of  an  aggravated  char¬ 
acter;  otherwise  the  local  disease  may  be  enhanced, 
by  the  unnecessary  injury  inflicted  upon  the  surround¬ 
ing  parts.  The  symptoms  often  appear  momentarily 
aggravated  by  the  local  application,  which  is  not  un- 
frequently  followed  by  an  attempt  to  dislodge  the 
membrane  by  vomiting.  Should  this  latter  result  fol¬ 
low,  the  tonsils  and  palate  will  appear  as  if  shrunken 


Drug  Treatment. 


193 


in  substance,  and  spotted  here  and  there  with  a  few 
drops  of  blood  upon  the  surface  formerly  occupied  by 
the  membrane. 

“  When  this  does  occur,  the  apjflication  may  be  re¬ 
newed  directly  upon  the  surface  of  the  gland,  in  order 
to  arrest  the  almost  invariable  disposition  of  the  mem¬ 
brane  to  renew  itself  upon  the  abraded  part.  As  the 
disease  progresses,  and  the  membrane  extends  toward 
or  into  the  pharynx,  the  difficulty  in  making  local  ap¬ 
plications  becomes  greatly  enhanced ;  but  the  practi¬ 
tioner  should  not  hesitate,  for  fear  of  inflicting  tempo¬ 
rary  pain,  from  thoroughly  exploring  and  covering  the 
parts  affected  with  the  solution  of  hydrochloric  acid. 
For  the  purpose  of  effecting  this,  it  is  often  necessary 
to  place  the  head  of  the  patient  upon  the  knee  of  an 
assistant,  and  with  a  sj>atula  to  depress  the  tongue  and 
the  lower  j  aw  firmly  at  the  same  time,  by  which  means 
a  view  of  the  whole  fauces  may  be  obtained,  and  an 
opportunity  afforded  of  making  a  thorough  application 
of  the  local  remedy. 

“Nitrate  of  silver  has  been  warmly  recommended 
by  Trosseau,  Guersant,  and  Yalleix,  in  France,  and 
was  the  application  almost  universally  resorted  to  in 
England  at  the  commencement  of  the  epidemic  in  that 
country.  The  usual  mode  of  using  nitrate  of  silver  in 
England  was  in  solution.  Dr.  Kingsland  advised  a  so¬ 
lution  of  16  grains  to  an  ounce  of  distilled  water  ;  and 
Dr.  Hart,  30  grains  to  an  ounce  of  distilled  water.  The 
mode  of  its  use  resembles  that  of  the  hydrochloric  acid. 

“  When  the  local  application  of  nitrate  of  silver  is 
made  in  a  solid  form,  care  should  be  taken  that  it  does 
not  slip  from  the  holder,  or  break,  as  in  such  an  event 
it  might  fall  into  the  stomach.  Such  an  accident  ac¬ 
tually  happened  to  M.  Guersant ;  fortunately,  liow- 

9 


194 


DlUTHEKIA. 


ever,  the  stomach  rejected  it ;  but  this  might  not 
always  occur,  and  few  medical  men  would  be  willing 
to  take  so  hazardous  a  risk.  Dr.  Hauner,  of  Austria, 
considers  nitrate  of  silver  as  the  very  best  local  appli¬ 
cation  to  the  diseased  surface,  and  advises  its  use  in  a 
solution  of  from  a  scruple  to  half  a  dram,  to  an  ounce 
of  water. 

“  Subsequent  experience  did  not  confirm  the  good 
opinion  entertained  for  nitrate  of  silver  among  the 
English  practitioners,  and  many  who  were  at  first  loud 
in  its  praises  came  to  disuse  it  altogether.  A  substi¬ 
tute  for  this  was  found  in  the  sesqui-chloride  of  iron, 
which  is  recommended  by  Dr.  Hanking  as  being  very 
efficacious  in  its  effects  upon  the  false  membrane.  He 
advises  its  use  in  the  form  of  a  gargle,  of  the  strength 
of  two  drams  to  eight  ounces  of  water,  to  be  applied 
to  the  throat  by  means  of  a  brush. 

“  In  the  United  States,  opinion  appears  to  be  divided 
as  to  the  best  local  application.  Dr.  Blake,  of  Sacra¬ 
mento,  has  found  the  greatest  benefit  resulting  from 
an  application  of  strong  hydrochloric  acid ;  a  view  in 
which  he  is  sustained  by  Dr.  Bynum  and  Dr.  Thomas, 
both  of  whom  have  had  much  experience  in  the  treat¬ 
ment  of  the  disease.  Prof.  Comegys,  of  Cincinnati,  is 
in  the  habit  of  applying  nitrate  of  silver,  either  in 
substance  or  strong  solution  in  water.  Sometimes, 
when  the  ulcerations  are  deep,  he  touches  them  with 
strong  nitric  acid,  by  means  of  a  brush.  In  some  cases 
he  has  employed  with  considerable  benefit  inhalations 
of  tannic  acid  dissolved  in  sulphuric  ether,  applied  by 
means  of  a  cloth  wetted  with  it,  to  the  mouth.  The 
formula  is : 


I E — Tannic  acid. 
Sulph.  ether 


M, 


f.  3ij. 
f-  fj- 


Drug  Treatment. 


195 


“  Dr.  Jacobi,  of  New  York,  who,  as  physician  to  the 
Canal  Street  Dispensary,  which  treats  a  large  number 
of  German  children,  has  had  a  very  large  experience, 
says : 

“  ‘  The  local  treatment  consists  of  cauterization  of 
the  membranes  and  surrounding  parts  with  the  solid 
nitrate  of  silver,  Or  with  strong  or  mild  solutions  of 
the  same  salt  in  water  (yss-j.  :  fj.) ;  of  gargles,  consist¬ 
ing  of  solutions  of  (or  applying  in  substance)  astrin¬ 
gents,  such  as  tannic  acid,  alum,  sulphate  of  zinc,  or 
claret  wine ;  in  gargling  with,  or  applying,  such  me¬ 
dicinal  agents  as  are  known  to  have  some  effect  on  the 
constitution  and  tissue  of  the  pseudo-membranes,  as 
chloride  of  potassium,  chlorates  of  potassa  and  soda, 
diluted  or  concentrated  nitric  or  muriatic  acids,  liquor 
of  sesqui-cliloride  of  iron,  etc.  Astringents  will  pre¬ 
vent  maceration,  render  the  exudation  dry  and  hard, 
and  alter  the  consistency  of  the  surrounding  hypersemic 
and  edematous  tissue.  It  will  thus  prevent,  sometimes, 
the  extension  of  pseudo-membranes  to  the  neighbor¬ 
hood  of  the  parts  already  affected,  and  in  some  cases 
may  accelerate  the  expulsion  of  the  membrane  as  a 
whole.  We  have  thus  seen  the  best  effects  from  tan¬ 
nic  acid,  either  applied  directly  to  the  parts  by  means 
of  a  curved  whalebone  probang,  or  dissolved  in  water 
as  a  gargle  (^ss-ii.  :  fi.)  Of  the  tinct.  sesquichlor.  iron 
we  have  seen  no  particular  effect.  Cauterizations  with 
nitrate  of  silver  we  have  found  to  be  generally  of  very 
little  use  when  applied  to  the  pharynx.  Its  effect  is 
superficial  only  ;  it  will  form  a  scurf,  but  will  destroy 
nothing.  Destruction  of  the  parts  can  not  be  effected 
except  by  forcing  the  caustic  into  and  below  the  mem¬ 
brane  ;  this  can  seldom  be  done  in  the  pharynx  of 
children,  and  for  this  reason  cauterization  is  unavailing 


0 


196 


Diptheria. 


at  this  point,  but  will  prove  beneficial,  we  believe,  by 
confining  the  process  of  exudation  to  its  original  local¬ 
ity.  In  cutaneous  diptheria  cauterization  may  be 
exercised  to  its  full  extent ;  but  as  these  cases  are  gen¬ 
erally  attended  with  extreme  prostration,  the  general 
treatment  will  prove  both  more  necessary  and  success¬ 
ful.  If  cauterization  is  to  be  resorted  to,  we  generally 
use,  and  with  good  effect,  more  or  less  concentrated 
muriatic,  or  acetic,  or  nitro-muriatic  acid.  Where, 
however,  cauterizations  are  made,  great  caution  is 
necessary  not  to  mistake  afterward  the  result  of  the 
caustic  for  pseudo-membrane.  This  remark  is  partic¬ 
ularly  applicable  where  nitrate  of  silver  has  been  used.’ 

“  Alum,  chloride  of  lime,  and  calomel  are  sometimes 
recommended.  When  their  use  is  deemed  advisable, 
they  may  be  applied  by  dipping  a  brush  or  the  finger 
in  the  dry  powder,  and  carrying  it  directly  to  the 
affected  part,  or  blowing  them  through  a  quill. 

“  Prof.  Metcalfe  advises  the  use  of  the  bromide  of 
iodine,  in  the  form  of  two  drops  to  an  ounce  of  the 
mucilage,  or  gum-arabic,  as  a  topical  application.  He 
also  gives  dram  doses  of  this  mixture  internally,  with 
the  happiest  results. 

“  When  there  is  a  considerable  accumulation  in  the 
nares  and  behind  the  velum,  the  debris  and  foul  secre¬ 
tions  may  be  removed,  and  much  temporary  relief 
obtained,  by  an  injection  of  an  infusion  of  chamomile 
with  a  few  drops  of  creosote,  which  may  be  best 
effected  by  a  laryngeal  syringe.  The  syringe  of  Dr. 
Warren,  of  Boston,  answers  a  very  good  purpose  for 
injecting  fluid  either  into  the  nares  or  below  the 
epiglottis.  It,  however,  is  liable  to  the  objection  that 
it  is  likely  to  produce  irritation,  by  coming  in  contact 
with  the  irritable  portion,  exactly  at  the  opening  of 


Drug  Treatment. 


197 


the  glottis,  which,  is  found,  by  the  researches  of  Prof. 
Horace  Green,  to  he  the  seat  of  sensibility,  instead  of 
the  epiglottis,  as  has  heretofore  been  supposed.  The 
common  glass  syringe,  with  either  a  curved  extremity 
or  a  straight  one — dependent  upon  the  part  to  be 
reached — answers  all  ordinary  purposes,  and  possesses 
the  advantage  of  being  easily  obtained  at  the  apothe¬ 
cary’s,  and  is  of  slight  cost. 

“  For  correcting  the  fetor  of  the  secretions,  the 
chloride  of  soda,  in  the  proportion  of  one  dram  to  six 
ounces  of  water,  may  be  used  with  much  benefit.  Dr. 
Hanking  suggests,  on  the  supposition  of  the  presence 
of  some  vegetable  parasite,  the  use  of  sulphurous  acid 
and  hyposulphate  of  soda,  in  the  form  of  a  saturated 
solution.  ‘  The  power  of  the  latter,’  he  adds,  ‘  in 
destroying  the  fungoid  growth  of  favus,  as  well  as  the 
oidium  which  infests  the  vine,  I  have  myself  experi¬ 
enced  ;  and  I  strongly  recommend  it,  provided  the 
vegetable  origin  of  diptheria  be  confirmed  by  further 
observations.’ 

u  Much  relief  is  often  afforded  by  inhalation,  espe¬ 
cially  after  the  second  or  third  day  of  the  attack.  An 
excellent  means  of  fumigation  is  to  pour  boiling  water 
upon  catnip,  or  the  leaves  of  any  similar  plant,  with 
the  addition  of  a  little  vinegar,  and  to  allow  the  patient 
to  inhale  the  fumes,  either  by  inclosing  the  head  under 
a  blanket,  or  by  applying  the  mouth  to  a  tube  con¬ 
nected  with  a  close  vessel  containing  the  materials 
from  which  the  vapor  is  generated.  The  immediate 
effect  of  fumigation  is  extremely  grateful  to  the 
patient.  Dr.  Gurdon  Buck  advises  the  addition  of 
Labarroque’s  solution  of  the  chloride  of  soda,  in  suc¬ 
cessive  portions  of  a  teaspoonful  each,  to  the  liquid 
used  for  fumigation.  Mr.  C.  T.  Hodson  recommends 


198 


Diptiiekia. 


the  inhalation  of  boiling  water,  to  which  has  been 
added  a  tablespoonful  of  chlorinated  lime. 

“  General  Treatment. — The  general  treatment  must 
be  regulated  by  the  type  of  the  disease.  Shortly  after 
the  ap23earance  of  M.  Bretonneau’s  treatise,  a  great 
variety  of  treatment  was  recommended  by  different 
practitioners,  all,  however,  with  a  view  to  arrest  in¬ 
flammatory  action.  Leeches  to  the  neck,  counter-irri¬ 
tation,  especially  by  means  of  blisters,  active  mercuri- 
alization,  and  purgative  medicines  furnished  the  basis 
of  most  of  the  plans  advised.  Calomel,  especially, 
obtained  great  celebrity,  and  was  at  one  time  con¬ 
sidered  as  the  most  effective  remedy  in  arresting  the 
progress  of  the  disease.  It  wns  first  prescribed  by  Dr. 
Conolly,  who  was  residing  at  Tours,  at  the  appearance 
of  the  disease ;  and  was  so  efficient  in  his  hands,  in 
minute  doses,  as  speedily  to  find  favor  with  the  French 
practitioners.  But,  whatever  may  have  been  the  suc¬ 
cess  attendant  upon  its  administration  at  that  time,  it 
is  now  found  to  require  great  caution  in  its  use. 

“  Blisters  are  contra-indicated,  and  so  far  from  fur¬ 
nishing  relief,  tend  to  increase  the  danger,  by  assum¬ 
ing  an  unhealthy,  and  frequently  sloughy,  appearance. 
The  bites  of  leeches  often  give  rise  to  passive  bleeding, 
extremely  difficult  to  arrest,  which  greatly  reduces  the 
already  exhausted  energies  of  the  patient.  Everything, 
in  fact,  which  tends  to  lower  the  powers  of  life,  or  in¬ 
duce  prostration,  should  be  sedulously  avoided,  in  the 
type  of  disease  which  at  present  prevails ;  and  cer¬ 
tainly  differs  from  that  for  which  Bretonneau,  Conolly, 
and  other  medical  men  in  France  at  that  period  were 
called  upon  to  prescribe. 

“  The  type  of  the  disease  as  it  now  prevails  exhibits 
a  tendency  to  extreme  prostration  from  the  very  begin- 


Drug-  Treatment. 


199 


ning,  and  requires  a  tonic  treatment  to  sustain  the  pa¬ 
tient.  The  most  effectual  method  of  accomplishing 
this  is  by  means  of  quinine,  the  various  preparations 
of  iron  and  steel,  stimulants,  in  the  form  of  brandy, 
milk  punch,  and  wine  whey,  and  a  generous  diet,  con¬ 
sisting  of  beef-tea,  Liebig’s  extract  cf  meat,  and  a 
strong  decoction  of  coffee.  Sulphate  of  quinine  may  be 
administered  in  grain  doses,  conjoined  to  two  grains  of 
the  sulphate  of  iron,  repeated  as  often  as  the  symptoms 
appear  to  require — usually  every  three  hours.  It  is 
well  to  alternate  this  remedy  with  doses  of  chlorate  of 
potassa,  which  appears  to  exercise  a  beneficial  influence 
upon  the  disease  of  the  mouth  and  throat.  Chlorate  of 
potassa  may  be  given  in  doses  of  from  five  to  ten  grains, 
in  distilled  water,  or  a  bitter  infusion.  Prof.  Barker, 
of  Mew  York,  advises  the  chlorate  of  potassa,  in  doses 
from  3ss.  to  z].  The  chloride  of  soda  has  been  recom¬ 
mended  with  the  same  intention,  but  does  not  appear 
to  be  equally  efficacious  with  the  chlorate  of  potassa. 

“  The  tincture  of  the  sesqui-chloride  of  iron  has  met 
with  much  favor  among  the  English  practitioners,  as  a 
tonic.  Dr.  Banking  gives  it  the  preference  to  other 
tonics,  although  he  frankly  admits  that  it  matters  but 
little  which  of  this  class  of  medicines  is  used,  provided 
the  strength  of  the  patient  be  sustained.  ‘  Personally,’ 
he  remarks,  6 1  give  the  preference  to  the  tincture  of 
the  sesqui-chloride  of  iron,  not  only  from  the  inference 
drawn  from  the  analogy  of  its  unquestionable  useful¬ 
ness  in  the  more  asthenic  forms  of  erysipelas,  but  also 
from  the  positive  evidence  of  its  benefit  derived  from 
the  experience  of  several  gentlemen  in  the  country, 
among  whom  I  may  mention  Mr.  Dix,  of  Smallburg; 
Mr.  Prentice,  of  Morth  Walsham  ;  and  Mr.  Cowles,  of 
Stalham  ;  each  of  which  has  had  unusual  opportune 


200 


Diptheeia. 


ties  of  testing  its  advantages.’  The  tincture  of  the 
sesqui- chloride  of  iron  may  be  administered  in  doses 
of  from  eight  to  sixteen  drops,  in  a  little  water. 

“  Whatever  may  be  the  success  or  ultimate  failure  of 
this  remedy,  its  first  introduction  into  the  treatment  of 
this  disease  is  undoubtedly  due  to  Professor  Thomas  P. 
Heslop,  of  Queen’s  College,  Birmingham,  who,  after 
repeated  trials  in  his  own  practice,  brought  it  to  the 
attention  of  his  clinical  class  at  Queen’s  Hospital  and 
the  Medico-Chirurgical  Society  of  Queen’s  College. 
His  own  success  appears  truly  astonishing.  ‘I  have 
given  in  this  disease,’  he  says,  6  to  an  adult  twenty-five 
minims  of  the  London  tincture  of  the  sesqui-chloride 
of  iron  every  two,  three,  or  four  hours,  and  have  con¬ 
joined  a  few  drops  of  dilute  hydrochloric  acid.  I  have 
also  applied  daily,  sometimes  twice  a  day,  by  means 
of  sponges,  a  solution  of  hydrochloric  acid,  but  little 
weaker  than  the  dilute  acid  of  the  London  Pharmaco¬ 
poeia,  and  have  always  enjoined  the  regular  use  of 
weak  gargles  of  the  same  acid.  This,  with  the  con¬ 
stant  administration  of  stimulants,  beef-tea,  milk  and 
jellies,  has  constituted  my  treatment;  and  I  repeat 
here,  what  I  have  already  stated  in  other  quarters,  that 
since  I  have  become  aware  of  the  value  of  this  medi¬ 
cation,  nearly  ten  months,  I  have  not  lost  one  case.’ 
An  excellent  formula  for  administering  a  combination 
of  chlorate  of  potassa  and  the  sesqui-chloride  of  iron 
is :  Chlorate  of  potassa,  from  eight  to  twenty  grains ; 
tincture  sesqui-chloride  of  iron,  ten  to  twenty-five 
drops ;  rose-water  or  orange-syrup,  one  dram ;  water, 
four  ounces.  Where  there  is  difficulty  in  administer¬ 
ing  medicine,  the  bulk  may  be  reduced  by  omitting 
the  water  altogether,  and  increasing  at  pleasure  the 
amount  of  syrup.  The  success  which  has  attended  the 


Drug  Treatment. 


201 


use  of  this  remedy  in  England  warrants  a  careful  trial 
of  its  merits  at  the  hands  of  practitioners  in'  the  United 
States. 

u  Where  the  disturbance  of  the  secretions  appears 
to  indicate  the  use  of  mercurial  preparations,  and  they 
are  not  positively  contra-indicated  by  the  depressed 
state  of  the  patient,  calomel  may  be  administered,  in 
doses  of  one  tenth  of  a  grain,  mixed  with  sugar,  and 
placed  dry  upon  the  tongue.  Dr.  Bigelow  has  found 
this  remedy  valuable  in  the  disease  as  it  prevails  at 
Paris  ;  and  Mr.  Thompson  was  equally  successful  with 
it  at  Launceston,  England.  Dr.  Anderson,  of  Mew 
York,  and  Dr.  Briggs,  of  Bichmond,  have  employed 
calomel  with  marked  benefit.  It  is  a  question,  when 
calomel  and  chlorate  of  potassa  are  administered  con¬ 
jointly,  whether  the  effects  of  the  potassa  do  not  en¬ 
tirely  annul  those  of  the  calomel.  Dr.  Bigelow,  as 
the  result  of  some  very  recent  observations,  says,  that 
although  it  may  retard  or  prevent  the  specific  effects 
on  the  salivary  glands,  it  does  not  in  any  way  modify 
its  action  upon  the  secretions.  It  may  be  well,  how¬ 
ever,  when  the  effect  of  the  calomel  is  important,  to 
intermit  the  use  of  chlorate  of  potassa  for  twenty-four 
hours,  or  to  alternate  the  use  of  these  medicines  at 
wide  intervals  between  the  administration  of  the 
two. 

“  Emetics  are  serviceable  when  portions  of  the  de¬ 
tached  membrane  are  lodged  in  the  throat,  without 
being  expelled,  or  when  the  disease  is  making  rapid 
progress,  and  threatens  to  invade  the  larynx.  The  ac¬ 
tion  of  the  emetic  in  this  instance  is  frequently  to  de¬ 
tach  the  pellicle  and  dislodge  the  pseudo-membrane. 
At  the  same  time  that  the  membrane  i^  thus  ejected, 
the  throat  is  relieved  of  the  foul  secretions  which 

9* 


202 


Diptheeia. 


might  otherwise  be  received  into  the  stomach,  to  the 
great  detriment  of  the  patient. 

“  But,  whatever  treatment  may  be  adopted,  the  fact 
should  never  be  lost  sight  of,  that  the  system  is  labor¬ 
ing  under  the  influence  of  a  powerful  and  most  de¬ 
pressing  poison  ;  and  it  matters  but  little,  so  far  as  the 
constitutional  treatment  is  concerned,  whether  this 
poison  be  at  first  local,  and  afterward  disseminated 
through  the  system,  or  is  from  the  beginning  of  a  gen¬ 
eral  character,  and  incidentally  developed  in  the  mu¬ 
cous  membranes  of  the  air-passages.  In  the  perform¬ 
ance  of  her  functions  in  the  elimination  of  this  poison, 
Mature  requires  to  be  sustained,  not  only  by  the  free 
nse  of  the  tonics  already  indicated,  but  by  a  liberal 
allowance  of  the  most  concentrated  and  nutritious  ar¬ 
ticles  of  diet,  in  which  beef-tea,  milk,  eggs,  brandy, 
wine,  and  coffee  stand  prominent.  When  there  is 
difficulty  in  swallowing,  not  only  these  articles  of  diet, 
but  quinine,  may  be  introduced,  by  means  of  injec¬ 
tions  ;  a  resort  to  which  should  not  be  deferred  until 
it  is  impossible  to  administer  medicines  by  the  mouth, 
but  whenever  the  difficulty  of  swallowing  becomes  at 
all  a  prominent  feature  in  the  complaint.  Injections 
should  not  be  administered  in  greater  quantities  than 
twro  ounces  at  a  time,  and  should  not  be  often  re¬ 
peated  ;  otherwise  they  will  give  rise  to  a  local  irrita¬ 
tion  in  the  rectum,  which  will  prevent  their  retention. 
One  or  more  drops  of  tincture  of  opii,  according  to  the 
age  of  the  patient,  will  greatly  aid  in  the  retention  of 
the  injection. 

“  After  the  violence  of  the  disease  has  been  checked, 
a  continuance  of  the  tonic  treatment  should  be  per¬ 
severed  in  for  some  time,  not  only  to  prevent  the  se¬ 
quelae  liable  to  follow7,  but  a  recurrence  of  the  attack, 


Drug  Treatment. 


203 


which  often  reappears  after  an  interval  of  several 
weeks,  especially  when  the  patient  is  exposed  to  those 
depressing  influences  which  are  too  frequently  attend¬ 
ant  upon  poverty  and  uncleanliness.” 

We  have  now  seen  what  “confusion  worse  con¬ 
founded”  exists  in  the  medical  profession  with  regard 
to  the  treatment  of  diptheria,  and  how  the  testimony 
of  medical  men  of  equal  character  and  experience  is 
both  for  and  against  all  plans  of  drug  treatment  which 
have  yet  been  adopted.  Some  recommend  the  stim¬ 
ulant  treatment ;  others  prefer  the  antiphlogistic  / 
some  rely  mainly  on  cauterizing  the  throat ;  others 
declare  caustics  to  be  injurious  ;  some  object  to  any 
strong  local  applications  because  the  disease  is  consti¬ 
tutional  /  others  object  to  powerful  constitutional 
treatment  because  the  disease  is  local ,  etc.  And  I  will 
conclude  this  “  budget  of  blunders”  with  a  few  quota¬ 
tions  from  the  latest  authors,  showing  that  the  dis¬ 
crepancies  among  physicians  are  still  as  wide  and 
irreconcilable  as  ever.  The  especial  object  I  have  in 
view  in  dwelling  so  long  on  drug-medication  is  to 
destroy  all  confidence  in  it,  and  I  know  of  no  more 
effectual  method  of  discrediting  the  system  than  that 
of  telling  the  people  what  its  advocates  allege  in  its 
favor. 

Dr.  A.  C.  Hamlin,  Surgeon  to  the  Second  Hegiment 
Maine  Volunteers,  reports  a  case  in  which  his  treat¬ 
ment  was  chlorate  of  potash,  gargles,  iodine  embroca¬ 
tions  externally,  inhalations  of  steam,  and  carbonate 
of  ammonia  and  brandy,  with  high  diet ,  internally  ; 
also  cauterization  with  solid  nitrate  of  silver ;  pieces 
of  ice  held  in  the  mouth  frequently  ;  sponge  baths, 
stimulants,  etc.  In  detailing  the  plan  and  effects  of 
treatment,  Dr.  Hamlin  makes  the  significant  statement, 


204 


DlPTIIEKIA. 


that  after  the  cauterization  the  disease  increased  in 
both  tonsils,  and  that,  on  applying  the  ice,  there  was 
an  immediate  improvement,  a  circumstance  the  import¬ 
ance  of  which  we  shall  be  better  enabled  to  understand 
after  we  have  examined  the  rationale  and  effects  of 
Hygienic  treatment. 

Dr.  Minot,  Secretary  of  the  Boston  Society  for  Med¬ 
ical  Improvement,  has  reported  in  the  Boston  Medical 
and  Surgical  Journal  for  March  21,  1861,  the  practice 
of  several  members  of  the  Society  :  Dr.  Lyman  treated 
a  case  with  chlorate  of  potash,  fever  mixture,  solid 
nitrate  of  silver  to  the  throat,  castor-ail,  wine,  beef-tea. 

Dr.  Lifield  stated  that,  in  the  cases  he  had  seen,  the 
application  of  solid  caustic  seemed  to  aggravate  the 
disease,  as  did  also  the  tincture  of  iodine. 

Dr.  Ainsworth  prescribed  strong  solution  of  nitrate 
of  silver,  chlorate  of  potash,  diluted  muriatic  acid, 
mustard  to  the  throat  and  neck,  citrate  of  magnesia, 
solid  nitrate  of  silver,  broth,  flax-seed  tea,  strong  solu¬ 
tion  of  capsicum,  per-chloride  of  iron,  enema  of  strong 
beef-tea  with  Madeira  wine,  and  wine  by  the  mouth. 

Dr.  Minot  reported  a  case  in  which  “  the  treatment 
consisted  in  the  administration  of  tonics,  stimulants, 
and  concentrated  nourishment.” 

By  “  concentrated  nourishment”  the  Doctor  probably 
means  diluted  slops,  broth,  beef-tea  and  wine,  brandy 
and  toddy,  of  which  we  have  already  seen  quite 
enough. 

Dr.  Jackson  reported  cases  treated  with  quinine  and 
muriate  of  iron  internally,  and  muriatic  acid  to  the 
throat.  He  states  that  nitrate  of  silver  was  at  first 
applied  to  the  throat,  but  seemed  to  do  harm.  An 
emetic  and  cathartic  generally  preceded  the  above 
treatment. 


Dkug-  Treatment. 


205 


Dr.  Tower,  of  South  Weymouth,  Mass.,  in  a  com¬ 
munication  to  Dr.  Bowditch,  published  in  the  Boston 
Medical  and  Surgical  Journal  for  March  7,  1861,  says  : 

“  The  treatment  which  I  have  pursued  has  been 
various,  but  that  which  has  found  most  favor  with  me 
is  the  free  and  frequent  exhibition  of  chlorate  of 
potassa ;  gargles  of  the  same,  or  of  water  acidulated 
with  muriatic  acid,  or,  what  is  still  better,  a  solution 
of  common  salt.  The  best  external  application  is  a  sat¬ 
urated  solution  of  common  salt.  I  say  this  after  trying 
various  rubefacients  and  cataplasms.  Cold  water  is 
employed  by  some,  but  I  have  never  used  it.  If  the 
disease  is  not  arrested  by  these  applications,  I  make 
use  of  a  strong  solution  of  nitrate  of  silver  (yi.  to  fi.). 
When  there  is  much  prostration,  stimulants,  tonics,  and 
plenty  of  beef-tea,  or  other  nourishment.” 

Dr.  W.  A.  Bryden,  of  Mayfield,  in  the  British  Med¬ 
ical  Journal  for  Mov.  21,  1857,  gives  us  his  plan  of 
treatment,  which  consists  essentially  in  the  use  of 
guaiacum  and  chloride  of  potash,  instead  of  the  appli¬ 
cation  of  the  solid  nitrate  of  silver,  which  he  regards 
as  injurious. 

Dr.  Bamskid,  of  the  Metropolitan  Free  Hospital, 
objects  to  strong  caustic  because,  “  in  more  than  one 
case,  it  has  seemed  to  increase  every  undesirable  symp¬ 
tom.”  This  plan  of  treatment  is  thus  given  in  the  Lon¬ 
don  Lancet  for  Feb.  19,  1859,  witli  a  case  to  illustrate  : 

“  A.,  a  young  lady,  aged  15,  of  good  condition  in 
life,  robust,  and  not  subject  to  any  of  the  influences 
supposed  to  be  favorable  to  the  development  of  the 
disease.  I  saw  her  on  the  third  day,  and  found  her  in 
bed,  tranquil,  capable  of  speaking  a  few  words  together, 
breathing  comfortably  without  noise,  swallowing  freely 
and  without  pain  anything  given  to  her ;  with  a  cool, 


206 


DirTHEMA. 


soft  skin,  and  silky  pulse,  beating  100.  The  sub  max¬ 
illary  and  cervical  glands  were  much  swollen.  She 
could  open  her  mouth  tolerably  well,  and  by  means 
of  a  spoon  a  very  distinct  view  of  the  interior  was 
obtained.  The  soft  palate  was  projecting,  strongly 
convex  on  to  the  base  of  the  tongue  ;  the  swelling 
eased  off  gradually,  terminating  on  the  hard  palate, 
within  half  an  inch  of  the  front  teeth  ;  it  was  covered 
in  patches  with  the  characteristic  false  membrane,  and 
everywhere  exuded  copiously  a  jelly-like,  tenacious 
fibrin.  By  drawing  forward  and  pressing  down  the 
tongue,  the  margin  of  the  false  palate  could  be  dis¬ 
tinctly  seen,  with  its  thick,  swollen  edge  dipping  down 
into  the  pharynx,  and  the  uvula  hanging  in  the  center, 
pale-red  and  free  from  disease,  or  at  most  very  slightly 
edematous.  The  tonsils  were  swollen,  and  agglutina¬ 
ted  to  the  edges  of  the  soft  palate,  and  so  matted  with 
effusion  of  false  membrane  and  fibrin  as  to  be  indis¬ 
tinguishable  from  the  latter. 

“  According  to  the  testimony  present,  the  disease 
was  decidedly  progressing  ;  there  was  more  exudation, 
and  the  swelling  was  greater  than  six  hours  before. 
It  was  resolved  to  remove  as  much  of  the  exudation  as 
possible,  no  force  being  used,  and  to  apply  a  strong 
solution  of  nitrate  of  silver,  eighteen  grains  to  the 
ounce.  In  four  hours  the  breathing  became  noisy, 
not  from  implication  of  the  larynx,  but  from  blocking 
of  the  posterior  nares,  from  increased  swelling  at  the 
back  part  of  the  velum,  and  effusion  of  fibrinous 
secretion  spotted  with  false  membrane,  and  the  corre¬ 
sponding  difficulty  of  ingress  of  air  by  the  mouth. 
Other  measures,  as  inhalation  and  gargling,  were 
adopted,  and  I  may  mention  that  the  former  always 
gave  most  relief.  On  the  fourth  day  the  report  was, 


Drug  Treatment. 


207 


that  the  noisy  breathing  had  considerably  diminished ; 
the  patient  had  slept  two  hours  and  a  half ;  at  intervals 
of  an  hour,  she  had  taken  medicine,  food,  and  wine, 
but  with  more  difficulty  than  yesterday,  and  once  the 
fluid  returned  by  the  nostrils  ;  the  anterior  part  of  the 
palate  was  less  swollen,  and  the  false  membrane  and 
fibrin  secreted  in  much  less  quantity  ;  but  the  breath¬ 
ing  was  much  more  noisy  than  yesterday,  and  the 
cervical  and  submaxillary  glands  much  more  swollen  ; 
general  symptoms,  pulse,  etc.,  as  before.  It  was  felt 
that  the  caustic  application  had  done  good  in  one 
direction  and  mischief  in  another ;  and  the  throat  was 
mopped  out,  after  removing  gently  all  the  exudation 
possible,  with  a  solution  of  nitrate  of  silver  ten  grains 
to  the  ounce. 

“  Tor  some  hours  the  breathing  was  less  noisy,  but 
the  difficulty  recurred.  Next  day  the  report  was — no 
sleep,  increased  difficulty  in  swallowing,  and  consider¬ 
able  accumulation  about  and  behind  the  fauces  ;  injec¬ 
tion  by  the  nares  returned  the  same  way  ;  occasional 
smothered  cough ;  the  cervical,  submaxillary,  and 
neighboring  glands  immensely  swollen.  The  mouth 
could  not  be  opened  wide  enough  to  examine  the 
throat.  Laryngeal  spasm  occurred  once,  and  wTas 
overcome  by  inhalation ;  again  in  two  hours,  and 
overcome  by  the  same  means.  Sonorous  respiration 
followed,  and  in  an  hour  a  third  spasm  of  the  glottis 
ushered  in  the  fatal  event. 

“  I  know  some  persons  may  fail  to  see  any  connec¬ 
tion  between  the  application  of  the  caustic  and  the 
increased  swelling  and  aggravation  of  symptoms  ;  and 
in  this  case  it  was  contended  by  my  consultant  that 
the  local  treatment  was  the  best  possible  under  the 
circumstances,  and  that  the  fatal  event  would  have 


208 


Diptheeia. 


occurred  as  soon  under  any  other  mode  of  treatment. 
I  confess  to  having  thought  so  at  the  time,  but  in¬ 
creased  experience  has  convinced  me  that  any  treat¬ 
ment  which  causes  rapidly  increasing  swelling  of  the 
cervical,  submaxillary,  and  neighboring  glands  is  bad, 
and  sure  to  be  attended  by  corresponding  extension  of 
the  disease  within  and  below  the  fauces,  by  declension 
of  power,  and  increase  in  the  difficulty  of  breathing, 
swallowing,  etc.  And  the  reason  is  obvious  enough. 
In  fact,  in  all  cases  where  the  first  application  of 
caustic  has  shown  the  tendency  to  excessive  glandular 
enlargements,  the  local  treatment  can  not  be  too 
soothing  and  gentle.  The  treatment  consisted  of 
quinine  in  three-grain  doses,  with  ether  and  muriatic 
acid,  and  given  in  rotation  with  strong  beef-tea  and 
wine,  so  that  every  hour  the  patient  took  medicine, 
food,  or  wine. 

“  The  treatment  in  which  I  have  most  faith,  on  or 
about  the  third  day,  under  the  circumstances  above 
mentioned,  is  the  following :  Let  as  much  of  the  exu¬ 
dation  as  is  easily  accessible  and  loose  be  removed.  A 
carefully  strained  infusion  of  chamomiles  is  to  be 
made,  to  which  is  added  a  few  drops  of  creosote  or  of 
liquor  calcis  chlorinata  (two  drams  to  fifteen  ounces), 
or  liquor  aluminis.  It  is  to  be  used  by  means  of  Cox- 
etter’s  laryngeal  syringe,  or  any  other  apparatus  the 
practitioner  may  advise,  so  as  to  avoid  the  unrest  of 
tissues  created  by  gargling.  The  laryngeal  syringe  is 
admirably  adapted  for  children,  who,  after  a  time,  will 
use  it  themselves,  although,  of  course,  not  very  effect¬ 
ually.  If  there  be  much  accumulation  behind  the 
velum,  and  discharge  passes  by  the  nares,  it  is  an  ex¬ 
ceedingly  useful  plan  to  syringe  the  throat  through  the 
anterior  nares,  with  the  same  infusion.  Most  of  the 


Drug  Treatment. 


209 


fluid  comes  back  by  the  mouth,  carrying  with  it  debris 
of  membrane  and  foul  secretions.  An  effect  at  deglu¬ 
tition  will  almost  always  be  made,  but  if  some  of  the 
infusion  be  swallowed  it  can  only  do  good.  Inhala¬ 
tion  from  a  hot  infusion  of  the  same  has  seemed  to 
give  more  ease  to  the  patient  than  any  other  applica¬ 
tion.  Washing  out  of  the  throat  should  not  be  insisted 
on  more  than  three  or  four  times  a  day — the  inhalation 
as  often  as  the  patient  may  wish.  The  chlorinated 
lime,  in  addition,  should  be  used  if  there  be  much 
fetor ;  the  alum  when  that  is  only  slightly  apparent. 
The  throat  outside  should  be  surrounded  by  a  poultice 
composed  of  the  strained  chamomile  flowers,  and 
changed  four  or  five  times  in  the  twenty-four  hours. 
Internally,  I  use  quinine  in  chamomile  infusion,  with 
muriatic  acid  and  ether,  and  endeavor  to  produce  cin- 
chonism.  I  use  chamomiles,  having  in  view  its 
reputed  efficacy  in  erysipelas  and  phlegmonous  inflam¬ 
mation.  In  one  case  only,  where  hematuria  existed, 
I  gave  tincture  of  acetate  of  iron,  with  acetate  of  pot¬ 
ash  in  small  quantity,  and  the  patient  did  well. 55 

Dr.  Richard  Cammack,  in  the  Lancet  for  Oct.  30, 
1858,  gives  us  the  following  : 

“  Treatment. — 1.  A  temperate,  dry,  well-ventilated 
room  as  can  be  obtained,  no  one  being  allowed  to 
sleep  in  it  except  an  attendant.  Crowded  bedrooms 
and  animal  effluvia  are  exciting  causes. 

“  2.  A  calomel  purgative,  varying  in  strength  ac¬ 
cording  to  the  age  and  size  of  the  patient ;  and  in  chil¬ 
dren,  where  symptoms  of  laryngitis  appear ;  a  rapid 
exhibition  of  the  chloride  of  mercury,  such  as  a  grain 
’to  two  grains  every  hour  till  the  breathing  is  easier, 
and  then  every  three  or  four  hours,  till  the  false  mem¬ 
branes  are  loosened,  the  bowels  evacuate  green  stools, 


210 


Diptheria. 


or  vomiting.  Care  is  needed  not  to  carry  the  mineral 
too  far,  but  it  can  be  borne  in  proportion  to  the  strength 
of  the  patient  and  the  sthenic  form  of  the  attack.  Chil¬ 
dren  who  have  been  healthy,  and  are  teething,  have 
most  inflammatory  symptoms. 

“  3.  The  decoction  of  cinchona  with  hydrochloric 
acid,  varying  the  dose  of  the  latter  from  one  minim  to 
ten  every  four  hours,  in  from  a  teaspoonful  to  two 
tablespoonfuls  of  the  former. 

“  4.  Gargle  with  chloride  of  sodium  and  vinegar,  a 
tablespoonful  of  each  in  a  teacupful  of  hot  water  ;  also 
inject  this  up  the  nostrils  when  they  are  becoming  ob¬ 
structed.  This  excels  all  other  gargles ;  it  relieves 
the  breathing  and  the  fetor,  and  causes  the  ulcers  to 
heal. 

“  5.  Apply  the  stick  of  nitrate  of  silver  to  every 
part  where  false  membrane  or  exudation  can  be  seen. 
By  means  of  Dr.  B.  Quain’s  tongue  depressor,  one  can 
see  far  and  wide  ;  but  when  the  patient  will  not  sub¬ 
mit  to  this,  and  when  the  disease  spreads  beyond  the 
reach  of  the  caustic  case,  a  probang  and  clean  sponge 
well  saturated  with  a  strong  solution  of  nitrate  of  sil¬ 
ver  will  answer. 

“  6.  Bub  the  external  fauces  with  compound  iodine 
ointment  night  and  morning ;  and  where  erysipelas 
may  appear,  apply  the  stick,  and  lay  on  the  plaster  of 
strong  mercury  ointment. 

“  7.  Beep  the  room  and  all  else  sweet  and  clean. 

u  8.  A  nutritious  diet  is  necessary.  A  little  mutton 
every  day  ;  boiled  milk,  rich  gruels,  and  beef-tea,  with 
hot  port-wine  and  water  (half  wine  with  sugar  and 
lemon),  for  all  above  ten  years  ;  and  warm  milk  and' 
water  for  minors.  All  things  should  be  taken  warm. 
Cold  drinks  are  exciting  causes. 


Drug  Treatment. 


211 


“  The  disease  is  not  infectious,  except,  perhaps,  under 
extraordin  ary  circumstances. 

“  Since  I  wrote  the  above  remarks,  I  have  seen  many 
cases.  I  am  convinced  the  malady  is  herpetic,  and, 
therefore,  would  have  called  it  so.  It  is  malignant 
frequently,  therefore  herpes  malignus  anginosus  would 
fully  specify  the  disease.  I  have  no  wish  to  encroach 
on  your  space,  but  beg  to  observe  that  the  medical 
gentlemen  of  this  neighborhood  are  much  at  variance 
as  to  the  nature  of  the  disease,  and  that  it  has  been 
very  fatal.  I  have  the  Lancet  from  the  commence¬ 
ment,  and  have  read  the  lectures  of  most  since  Sir  A. 
Cooper’s  and  Mr.  Abernethy’s  ;  but  I  have  never  seen 
a  full  description  of  this  epidemic.” 

And  next  comes  Dr.  E.  Peney,  of  Marden,  Kent 
( Medical  Times  and  Gazette ,  March  5,  1859),  with  tur¬ 
pentine  as  the  leading  remedial  agent.  Dr.  Peney 
remarks : 

“  I  have  tried  almost  everything  that  I  know  to  have 
been  recommended,  and  have  failed  ;  and,  perhaps,  we 
often  shall  fail  under  any  treatment ;  but  I  think  it 
proper  to  mention  a  treatment  which  has  been  success¬ 
ful  with  me  in  three  or  four  cases  of  late.  It  is  for  a 
child  of  from  two  to  six  years  of  age.  Ten  minims  of 
the  spiritus  terebinthum  every  second  hour,  and  five 
grains  of  the  ammonite  carbonae  every  second  hour, 
the  child  taking  the  turpentine  one  hour  and  the  am¬ 
monias  next  hour. 

“  I  rub  up  3ij.  of  the  spiritus  terebinthum  with  the 
yolk  of  an  egg,  and  add  enough  syrup  to  make  a  3xij. 
mixture.  One  teaspoonful  in  milk  every  two  hours. 
Then  dissolve  3j*.  of  the  ammonise  carbonae  in  3xij.  of 
water,  and  give  one  teaspoonful  every  two  hours  also 
in  milk. 


212 


Diptheeia. 


“  Besides  this  the  child  takes  port  wine,  porter,  and 
beef-tea,  or  wine  with  the  yolk  of  an  egg  ad  lib.  I 
have  not  found  in  any  of  my  cases  strangury  caused 
by  the  turpentine.  The  patient  dislikes  it  of  course, 
and  it  requires  a  determined  and  attentive  nurse  ;  but 
I  have  found  the  plan  very  successful,  and  I  speak  of 
those  cases  where  decided  croupy  breathing  and  fits  of 
suffocation  have  made  their  appearance. 

“  I  was  induced  to  try  the  turpentine  from  having 
noted  its  effects,  when  given  as  advised  by  Mr.  Carmi¬ 
chael  in  cases  of  iritis  in  broken-down  constitutions 
where  mercury  could  not  be  used,  and  where  there  is 
so  great  a  tendency  to  the  effusion  of  lymph  in  the 
chambers  of  the  eye.  We  all  know,  too,  how  effectual 
it  is  in  other  diseases — acting  like  mercury  in  many 
respects — but  stimulating  instead  of  debilitating — and 
hence  its  appropriateness  in  diptheria,  where  mercury, 
I  believe,  hastens  the  fatal  result.  I  now  have  recourse 
to  no  sponging  the  fauces  with  strong  acid,  or  the  ar- 
genti  nitras,  which  I  used  to  do,  punishing  a  great  deal 
and  doing  very  little  good.” 

Dr.  J.  C.  S.  Jennings,  in  the  British  Medical  Jour¬ 
nal ,  July  16, 1859,  describes  a  plan  of  treatment  which 
he  claims  to  have  been  successful,  and  which  is.  in  all 
important  particulars,  so  far  as  the  drug  remedies  are 
concerned,  in  direct  antagonism  with  the  stimulating 
plan  of  Professor  Clark  and  others.  Indeed,  its  lead¬ 
ing  agents  are  the  most  deadly  antiphlogistics  known 
to  the  materia  medica.  Dr.  Jennings  says  : 

“  The  plan  I  have  invariably  adopted,  regardless  of 
sex,  or  age,  or  incubation  of  disease,  has  been  to  give 
an  emetic  of  antimonial  wine,  from  half  an  ounce  to 
an  ounce,  according  to  age  ;  to  freely  cauterize  the 
throat  with  solid  nitrate  of  silver ;  to  have  a  mustard 


Drug  Treatment. 


213 


poultice  applied  from  ear  to  ear ;  the  feet  and  legs 
plunged  in  a  hot  hath;  and  the  patient  confined  to 
bed.  After  the  emetic  action  has  ceased,  from  three  to 
five  grains  of  calomel  with  five  of  compound  extract 
of  colocynth  were  given  (or,  for  a  child  two  grains  of 
calomel  with  two  grains  of  compound  antimonial  pow¬ 
der),  and,  four  hours  after,  a  mixture  of  bisulphate  of 
quinia,  chlorate  of  potash,  and  diluted  hydrochloric 
acid.  A  gargle  of  chlorine  solution  was  directed  to 
be  used  frequently.  When  the  inflammatory  stage 
has  been  severe,  the  fauces  tense  and  shining,  and  the 
throat  edematous,  spirit  of  nitrous  ether  and  liquor  of 
acetate  of  ammonia,  or  nitrate  of  potassa,  has  been 
added  to  the  mixture. 

“  The  diet  has  been  at  first  farinaceous,  and  after¬ 
ward  consisting  of  strong  broths  and  jellies.  Stimu¬ 
lants  have  been  very  rarely  administered,  and  then 
only  as  sherry  whey,  alternately  with  the  quinine, 
which  I  have  trusted  to  as  the  sheet-anchor.  For  in¬ 
fants,  quinine  may  be  given  in  jelly,  washed  down 
with  a  mixture  of  tincture  of  sesqui- chloride  of  iron. 
Too  much  stress  can  not  be  laid  upon  tartar  emetic, 
quinine  in  large  doses,  and  the  avoidance  or  guarded 
use  of  alcoholic  stimulants.” 

The  treatment  recommended  and  practiced  by  Dr. 
Smith,  of  St.  Mary  Cray,  Kent  ( British  Medical  Jour¬ 
nal ,  July  16,  1859),  is  essentially  the  opposite  of  that 
of  Dr.  Jennings;  and  as  his  experience  and  observa¬ 
tions  are,  on  several  points,  in  direct  conflict  with  those 
of  several  authors  we  have  just  quoted,  I  give  his  re¬ 
marks  in  full : 

“  The  principles  that  have  guided  my  treatment  of 
this  disease  are :  first,  to  arrest  the  local  inflammation 
by  exciting  another  of  a  different  character ;  second ,  to 


214 


Diptheria. 


employ  elimination  according  to  the  individual  case  ; 
third ,  in  all  cases  to  sustain  vigorously '  the  vital 
powers. 

“  To  accomplish  the  first  indication,  I  prefer  the  em¬ 
ployment  of  a  strong  solution  of  the  nitrate  of  silver. 
Having  first  cleared  the  fauces,  etc.,  as  far  as  practica¬ 
ble  by  gentle  means,  I  paint  every  affected  part,  and 
beyond  it,  with  the  solution,  of  the  strength  of  fifteen 
grains  to  a  dram.  In  mild  cases  I  have  frequently 
tried  one  of  milder  strength,  say  five  grains  ;  but  I  am 
satisfied  that  in  all  cases  an  efficient  application  of  the 
full  strength  is  the  best.  It  is  perfectly  safe,  and  has 
at  once  a  marked  effect.  It  is  more  efficiently  applied 
by  a  full-sized  camel-hair  pencil  than  a  sponge.  Se¬ 
vere  cases  must  be  seen  again  in  twelve  hours,  and  the 
application  repeated  should  the  so-called  membrane 
spread.  Later  in  the  treatment,  a  weaker  solution 
may  be  used,  or  Bretonneau’s  application,  one  part  of 
hydrochloric  acid  to  three  of  honey.  And  later  still, 
when  the  membrane  has  disappeared,  but  much  full¬ 
ness  and  puffiness  of  the  parts  continue,  a  gargle,  con¬ 
taining  the  sesqui-chloride  of  iron,  or  taunic  acid. 
Where,  as  in  my  second  case,  there  is  much  fetor,  the 
chlorate  of  potassa  is  applicable.  And  where,  as  in  my 
third  case,  there  is  more  tonsillitis,  we  may,  with  ad¬ 
vantage,  employ  inhalation  of  steam,  or  warm  milk 
gargle.  After  the  membrane  is  removed,  and  the  ten¬ 
dency  to  diptheritic  deposit  supposed  to  be  arrested, 
the  throat  must  be  carefully  watched  ;  for  until  the  en¬ 
demic  condition  of  the  system  is  conquered,  we  may 
have  a  relapse  of  diptheria. 

“  I  commence  the  treatment  of  almost  every  case 
with  a  purge,  varying  with  the  state  of  the  tongue, 
pulse,  etc. ;  but  by  far  the  most  frequently,  calomel 


Drug  Treatment. 


215 


and  rhubarb,  carefully  avoiding  salines.  In  some 
cases,  with  loaded  tongue  and  suffused  countenances, 
I  have  given,  with  the  greatest  advantage,  emetics. 
Indeed,  I  am  now  so  satisfied  of  their  value,  that  I 
shall  for  the  future  employ  them  more  frequently,  es¬ 
pecially  where  the  congestion  is  marked,  or  there  is 
unusual  tonsillitis.  The  further  general  treatment  is 
of  great  importance,  namely,  that  directed  to  sustain 
the  vital  powers  and  remove  angemia. 

u  I  need  not  dwell  upon  the  necessity  of  wine,  beef- 
tea,  etc.  In  the  severe  cases  these  are  most  urgently 
required,  and  must  be  liberally  supplied.  In  the  more 
trifling  cases,  if  well  marked,  convalescence  will  be 
delayed,  and  danger  of  relapse  continue,  if  these,  or 
their  equivalents,  are  not  employed. 

“  Of  all  the  medicines  that  may  present  themselves 
for  our  choice,  .there  is  one  far  superior,  in  my  experi¬ 
ence,  to  all  others ;  and  upon  which  I,  indeed,  chiefly 
rely  :  tincture  of  sesqui-chloride  of  iron.  I  have  tried 
others  that  were  obvious ;  but  none  sustain  the  vital 
powers,  steady  the  pulse,  lessen  its  frequency,  and  give 
potency  to  it ;  none  remove  the  soft  clam  of  the  skin, 
steady  the  action  of  the  kidney,  and  remove  the  anae¬ 
mic  pallor  of  the  face,  as  does  this.  My  confidence  in 
its  employment,  and  also  in  the  use  of  the  nitrate  of  sil¬ 
ver,  is  fortified  by  their  effects  in  erysipelas,  in  which 
they  are  almost  specific.  Cases  will  occur  in  which 
this  treatment  must  be  deferred,  or  modified,  as  where 
the  tonsillitis  is  severe.  In  those  cases,  with  the  appro¬ 
priate  local  treatment,  I  have  first  used  the  decoction 
of  cinchona,  with  liquor  of  acetate  of  ammonia,  or  the 
latter  with  ammonia ;  but  we  afterward  come  to  the 
steel. 

“  Such  is  a  brief  outline,  and  time  admits  of  no 


216 


Diptheria. 


more,  of  the  treatment  of  cases  in  which  croup  has 
not  intervened.  How  are  we  to  meet  this  formidable 
extension  of  the  disease  ?  •  Shall  we,  in  any  cases,  re¬ 
sort  to  tracheotomy  ?  I  think  not.  Success,  in  re¬ 
ported  cases,  has  not  justified  it;  and  we  can  not  tell 
how  far  the  membranous  deposit  has  extended.  I 
have  had  urgent  cases  of  this  description,  and,  happily, 
have  hitherto  treated  them  with  success.  My  sheet- 
anchor  is  emetics,  repeated,  and  very  active  ones,  al¬ 
ways  of  ipecacuanha  and  sulphate  of  zinc,  never  of  an¬ 
timony. 

“  Did  time  admit,  I  would  detail  these  cases,  but 
they  present  no  peculiarity  except  the  urgency  of  the 
symptoms.  In  one  child,  three  years  of  age,  I  gave 
seven  emetics  before  the  symptoms  were  fully  relieved. 
Portions  of  the  membrane  were  detached  and  thrown 
off  in  the  act  of  vomiting.  I  gave  wine  and  ammonia 
in  the  intervals.  In  this  case  I  gave  also  repeated 
small  doses  of  calomel,  because  Bre tonneau  recom¬ 
mends  it :  and  the  case  being  of  extreme  urgency,  I 
would  not  neglect  one  of  such  authority. 

u  In  the  more  severe  cases  of  diptheria,  I  can  not 
too  impressively  recommend  strict  horizontal  position. 
I  have  seen  more  than  one  case  in  which  fatal  syncope 
was  to  be  apprehended  if  this  had  been  neglected.” 

But  a  truce  with  druggery.  Me  have  had  enough 
of  it.  We  have  been  surfeited  with  the  contradic¬ 
tory  stories  of  their  virtues  and  their  bad  effects,  and 
with  the  absurd  reasonings  and  conflicting  state¬ 
ments  of  their  advocates  and  authors.  And  I  conclude 
this  chapter  of  inconsistencies  with  an  article  written 
more  than  a  century  ago,  and  published  in  Boston  in 
1740.  The  discriminating  reader  will  readily  perceive 
that,  however  much  physicians  have  progressed  in  the 


Drttq  Treatment. 


217 


grammar  school,  they  have,  so  far  as  the  treatment  of 
malignant  diseases  is  concerned,  “  advanced  backward” 
since  the  following  article  wras  published.  It  was 
written  to  a  friend  by  a  clergyman,  in  reference  to 
what  has  since  been  called,  “  The  Throat-Distemper 
of  the  Last  Century,”  and  which  is  supposed  by  many 
to  be  identical  with  the  now  prevalent  diptheria. 

u  Sir — In  Compliance  with  your  Desire,  I  shall  now 
communicate  to  you  some  of  those  Observations  I  have 
made  upon  that  extraordinary  Disease,  which  has 
made  such  awful  Desolations  in  the  Country,  com¬ 
monly  called  the  Throat-Distemper. 

“  This  Distemper  first  began  in  these  Parts,  in  Pebr. 
1734,5.  The  long  continuance  and  universal  Spread 
of  it  among  us,  has  given  me  abundant  Opportunity 
to  be  acquainted  with  it  in  all  its  Forms. 

“  The  first  Assault  was  in  a  Family  about  ten  Miles 
from  me,  which  proved  fatal  to  eight  of  the  Children 
in  about  a  Fortnight.  Being  called  to  visit  the  dis¬ 
tressed  Family,  I  found  upon  my  arrival  there,  one  of 
the  Children  newly  dead,  which  gave  me  the  Advan¬ 
tage  of  a  Dissection,  and  thereby  a  better  Acquaint¬ 
ance  with  the  Mature  of  the  Disease,  than  I  could 
otherwise  have  had :  From  which  (and  other  like) 
Observations,  I  came  pretty  early  into  the  Methods  of 
Cure  that  I  have  not  yet  seen  Beason  to  change. 

“  There  have  few  Distempers  been  ever  known,  that 
have  put  on  a  greater  variety  of  Types,  and  appear’d 
with  more  different  Symptoms,  than  this  has  done  ; 
which  makes  it  necessary  to  be  something  particular 
in  describing  it,  in  order  to  set  it  in  a  just  Yiew,  and 
to  propose  the  Methods  of  Cure  necessary  in  its  several 
Appearances.  And 

“  1.  I  take  this  Disease  to  be  naturally  an  Eruptive 

10 


218 


Dipthekia. 


milliary  Fever :  and  when  it  appears  as  such,  it 
usually  begins  with  a  Shivering,  a  Chill,  or  with 
Stretching,  or  Yawning  ;  which  is  quickly  succeeded 
with  a  sore  Throat,  a  Tumefaction  of  the  Tonsils,  Uvula 
and  Epiglottis,  and  sometimes  of  the  Jaws,  and  even 
of  the  whole  Throat  &  Heck.  The  Fever  is  often  acute, 
the  Pulse  quick  &  high,  and  the  Countenance  florid. 
The  Tonsils  first,  and  in  a  little  Time  the  whole  Throat 
covered  with  a  whitish  Crustula,  the  Tongue  furr’d, 
and  the  Breath  fetid.  Upon  the  2d,  3d,  or  4th  Day, 
if  proper  Methods  are  used,  the  Patient  is  covered  with 
a  milliary  Eruption,  in  some  exactly  resembling  the 
Measles,  in  others  more  like  the  Scarlet  Fever  (for 
which  Distemper  it  has  frequently  been  mistaken)  but 
in  others  it  ^ery  much  resembles  the  confluent  Small 
Pox.  "When  che  Eruption  is  finished,  the  Tumefaction 
everywhere  subsides,  the  Fever  abates,  and  the  Slough 
in  the  Throat  casts  off  and  falls.  The  Eruption  often 
disappears  about  the  6th  or  7th  Day  ;  tho’  it  sometimes 
continues  visible  much  longer.  After  the  Eruption  is 
over,  the  Cuticle  scales  and  falls  off,  as  in  the  Con¬ 
clusion  of  Scarlet  Fever.  If  after  the  Crise  of  this 
Disease  Purging  be  neglected,  the  Sick  may  seem  to 
recover  Health  and  Strength  for  a  while  ;  yet  they 
frequently  in  a  little  Time  fall  again  into  grievous 
Disorders  ;  such  as  a  great  prostration  of  Strength,  loss 
of  Appetite,  hectical  Appearances,  sometimes  great 
Dimness  of  Sight,  and  often  such  a  weakness  in  the 
Joints  as  deprives  them  of  the  Use  of  all  their  Limbs ; 
and  some  of  them  are  affected  with  scorbutick  Symp¬ 
toms  of  almost  every  Kind. 

“  When  this  Distemper  appears  in  the  Form  now 
described,  it  is  not  very  dangerous  :  I  have  seldom 
seen  any  die  with  it,  unless  by  a  sudden  Looseness, 


Drug  Treatment. 


219 


that  calls  in  the  Eruptions  ;  or  by  some  very  irregular 
Treatment.  But  there  are  several  other  very  different 
Appearances  of  the  Disease,  which  are  attended  with 
more  frightful  &  deadly  consequences. 

“  2.  It  frequently  begins  with  a  slight  Indisposition, 
much  resembling  an  ordinary  Cold,  with  a  listless 
habit,  a  slow  &  scarce  discernible  Fever,  some  sore¬ 
ness  of  the  Throat  and  Tumefaction  of  the  Tonsils  ; 
and  perhaps  a  running  of  the  Hose,  the  countenance 
pale,  and  the  Eyes  dull  and  heavy.  The  patient  is  not 
confin’d,  nor  any  Danger  apprehended  for  some  Days, 
till  the  Fever  gradually  increases,  the  whole  throat, 
and  sometimes  the  Hoof  of  the  Mouth  and  Nostrils,  are 
covered  with  a  cankerous  Crust,  which  corrodes  the 
contiguous  Parts,  and  frequently  terminates  in  a  mortal 
Gangreen,  if  not  by  seasonable  Applications  pre¬ 
vented.  The  Stomach  is  sometimes,  and  the  Lungs 
often,  covered  with  the  same  Crustula.  The  former 
Case  is  discovered  by  a  vehement  Sickness  of  the 
Stomach,  a  perpetual  vomiting  ;  and  sometimes  by 
ejecting  of  black  or  rusty  and  fetid  Matter,  having 
Scales  like  Bran  mixed  with  it,  which  is  a  certain 
Index  of  a  fatal  Mortification. — When  the  Lungs  are 
thus  affected,  the  Patient  is  first  afflicted  with  a  dry 
hollow  Cough,  which  is  quickly  succeeded  with  an 
extraordinary  Hoarseness  and  total  Loss  of  the  Voice, 
with  the  most  distressing  asthmatic  Symptoms  and 
difficulty  of  Breathing,  under  which  the  poor  miserable 
Creature  struggles,  until  released  by  a  perfect  Suffoca¬ 
tion,  or  stoppage  of  Breath. — This  last  has  been  the 
fatal  Symptom,  under  which  the  most  have  sunk,  that 
have  died  in  these  Parts.  And  indeed  there  have 
comparatively  but  few  recovered,  whose  Lungs  have 
been  thus  affected.  All  that  I  have  seen  to  get  over 


220 


Dipthekia. 


tills  dreadful  Symptom,  have  fallen  into  a  Ptyalism  or 
Salivation,  equal  to  a  petit  Flux  de  Bouclie,  and  have 
by  their  perpetual  Cough  expectorated  incredible 
Quantities  of  a  tough  whitish  Slough  from  their  Lungs, 
for  a  considerable  Time  together.  And  on  the  other 
Hand,  I  have  seen  large  Pieces  of  this  Crust,  several 
Inches  long  and  near  an  Inch  broad,  torn  from  the 
Lungs  by  the  vehemence  of  the  Cough,  without  any 
Signs  of  Digestion,  or  possibility  of  obtaining  it. 

“  Before  I  dismiss  this  Plead,  I  must  observe  that 
the  Fever  which  introduces  the  terrible  Symptoms 
now  described,  does  not  always  make  such  a  slow  and 
gradual  Approach :  but  sometimes  makes  a  fiercer 
Attack ;  and  might  probably  be  thrown  off  by  the 
Eruptions,  and  this  Train  of  Terrors  prevented,  if 
proper  Methods  were  seasonably  used. 

“  3.  This  Distemper  sometimes  appears  in  the  Form 
of  an  Erysipelas.  The  Face  suddenly  inflames  and 
swells,  the  Skin  appears  of  a  darkish  Bed,  the  Eyes 
are  closed  with  the  Tumefaction,  which  also  sometimes 
extends  through  the  whole  Heck  and  Chest.  Blisters 
or  other  small  Ulcers  here  and  there  break  out  upon 
the  Tumor,  which  corrode  the  adjacent  Parts ;  and 
quickly  bring  on  a  Mortification,  if  not  by  some  happy 
Means  prevented.  Some  that  are  thus  affected,  are  at 
the  same  time  exercised  with  all  the  terrible  internal 
Symptoms  above  described  ;  and  some  with  none  of 
them.  If  this  inflamed  Tumor  be  not  quickly  dis¬ 
cussed,  it  will  (I  think)  always  prove  mortal. 

“  4.  Another  Appearance  of  this  Disease  is  in  ex¬ 
ternal  Ulcers  ;  which  break  out  frequently  behind  the 
Ears ;  sometimes  they  cover  the  wdiole  Head  and 
Forehead  ;  sometimes  they  appear  in  the  Arm-Pits, 
Groins,  Havil,  Buttocks  or  Seat ;  and  sometimes  in  any 


Drug  Treatment. 


221 


of  the  extream  Parts.  These  are  covered  with  the 

same  Kind  of  whitish  Crustula  above  described,  which 

✓ 

also  corrodes  the  contiguous  Parts  ;  and  quickly,  if 
not  prevented,  ends  in  a  Mortification.  I  have  ordi¬ 
narily  observed,  that  if  these  outward  Ulcers  are 
speedily  cured,  the  Throat  and  internal  Parts  remain 
free  from  the  above  mentioned  terrible  Symptoms  ; 
otherwise  the  miserable  Patient  must  pass  thro’  the 
whole  tragical  Scene  of  Terrors  before  represented,  if 
an  external  Gangreen  don’t  terminate  his  Agony  and 
Life  together. 

“  5.  Sometimes  this  Disease  appears  first  in  Bubo’s 
under  the  Ears,  Jaws,  or  Chin,  or  in  the  Arm-Pits,  or 
Groin.  These,  if  quickly  ripened,  make  a  consider¬ 
able  Discharge ;  which  brings  a  salutary  end  to  the 
Disease  ;  otherwise  they  quickly  end  in  a  fatal  Mortifi¬ 
cation  ;  or  else  bring  on  the  whole  foremention’d 
Tragedy. 

“  6.  This  disease  appears  sometimes  in  the  Form  of 
a  Quinseyn  The  Lungs  are  inflamed,  the  Throat  and 
especially  the  Epiglottis  exceedingly  tumefied.  In  a 
few  Hours  the  Sick  is  brought  to  the  Height  of  an  Or- 
thopnoea ;  and  can  not  breathe  but  in  an  erect  Pos¬ 
ture,  and  then  with  great  Difficulty  and  Hoise.  This 
may  be  distinguished  from  an  Angina,  by  the  Crustula 
in  the  Throat,  which  determines  it  to  be  a  Sprout  from 
the  same  Boot  with  the  Symptoms  described  above. 
In  this  Case  the  Patient  sometimes  dies  in  twenty-four 
Hours.  I  have  not  seen  any  one  survive  the  third 
Day.  But  thro’  the  divine  Goodness  these  symptoms 
have  been  more  rarely  seen  among  us,  and  there  have 
been  but  few  in  this  Manner  snatched  out  of  the 
world. 

“  As  the  Symptoms  of  this  Distemper  are  very  dif- 


222 


Dipthekia. 


ferent,  so  the  Methods  of  Cure  should  be  respectively 
accommodated  to  them  ;  and  I  shall  therefore  consider 
them  distinctly. 

“  When  this  Distemper  makes  its  Attack  with  the 
Symptoms  of  a  high  Eever,  a  florid  Countenance  &c. 
(as  in  the  first  Case  described)  the  first  Intention,  to  be 
pursued  towards  a  Cure,  is  to  bring  out  the  Eruptions 
as  soon  as  possible  ;  to  which  End,  I  order  the  Patient 
to  be  confin’d  in  Bed,  and  put  into  a  gentle  breathing 
Sweat,  till  they  appear.  A  Tea  made  with  Yirginian 
Snake-Boot  and  English  Saffron,  with  a  few  Grains  of 
Cochineal ;  A  Posset  made  with  Carduus  Marise  boil’d 
in  Milk,  and  turn’d  with  Wine,  the  Lapis  contrayerva, 
or  Gascoign-Powder ;  any  or  all  of  these,  as  occasions 
require,  answer  to  this  Purpose,  and  seldom  fail  of 
Success. 

“  One  of  the  most  dangerous  Circumstances  that  at¬ 
tend  this  Disease,  is  a  Looseness,  that  frequently  hap¬ 
pens  upon  the  first  Appearance  of  the  Eruptions ; 
which  must  be  speedily  restrain’d,  and  the  Belly  kept 
bound,  lest  the  morbifick  Matter  evaporated  by  the 
Pores,  be  recalled  into  the  Blood,  and  prove  suddenly 
fatal. — To  that  Purpose,  I  ordinarily  advise  to  Yenice- 
Treacle,  or  liquid  Laudanum,  which  commonly  answer 
all  intentions.  But  if  the  Patient  should  be  in  a  doz¬ 
ing  Habit,  that  these  cannot  be  used,  or  if  these  should 
fail  of  Success,  any  other  Astringent  may  be  used  that 
is  proper  in  a  Diarrhoea. 

“The  Ulcers  in  the  Throat  should  be  constantly 
cleansed,  from  the  Time  of  their  first  Appearance.  I 
have  found  the  following  Method  most  successful  to 
this  Purpose.  Take  Koman  Yitriol,  let  it  lie  as  near 
the  fire  as  a  Man  can  bear  his  Hand,  till  it  be  thor¬ 
oughly  calcined  and  turn’d  white :  Put  about  eight 


Drug  Treatment, 


223 


Grains  of  this  into  half  a  Pint  of  Water  ;  Lay  down 
the  Tongue  with  a  Spatula ;  and  gently  wash  off  as 
much  of  the  Crust  as  will  easily  separate,  with  a  fine 
Pagg  fastened  to  the  End  of  a  Probe  or  Stick,  and  wet 
in  this  liquor  made  warm.  This  Operation  should  he 
repeated  every  three  or  four  Hours. 

“  After  the  Eruptions  are  quite  gone,  the  Patient 
should  he  purged  two  or  three  Times,  to  prevent  the 
Consequences  above  described  ;  and  this  Pule  should 
he  observed  in  every  Form  of  the  Disease. 

“  If  after  the  Crise  of  this  Disease,  in  any  of  its  Ap¬ 
pearances,  the  Sick  should  fall  into  any  of  the  Disor¬ 
ders  mentioned  under  the  first  Head,  such  as  Loss  of 
Strength,  a  feverish  ILabit,  Dimness  of  Sight,  Weak¬ 
ness  of  the  Joynts  &c.,  Pepeated  Purging,  as  far  as 
the  Patient’s  Strength  will  bear,  with  Elixir  Proprieta- 
tis,  given  twice  a  Day  in  a  glass  of  generous  Wine, 
will  constantly  remove  these  Difficulties. 

“  When  this  Disease  makes  a  more  slow  and  leis¬ 
urely  approach  with  a  lingering  Fever,  pale  Counten¬ 
ance  &c.  as  described  in  the  second  Case,  all  Attempts 
to  bring  out  the  milliary  Eruptions  seem  in  vain.  And 
therefore,  tho1  the  Sick  may  be  very  much  relieved  by 
the  diaphoretick  Medicines  abovementioned,  if  repeat¬ 
edly  used  during  the  Course  of  the  Illness  ;  yet  these 
are  not  to  be  depended  upon  for  a  Cure.  But  a  brisk 
Purge  should  be  also  directed  every  third  Day,  and 
those  Cathartics  that  are  mixt  with  Calomel  or  Mer- 
curius  dulcis,  are  most  likely  to  be  serviceable, 
where  the  Age  and  Strength  of  the  Patient  will 
bear  it. 

“  If  there  be  an  extream  nauseating,  and  vehement 
Sickness  of  the  Stomach,  that  can’t  be  otherwise 
quieted,  an  Emetick  seems  necessary,  tho’  I  have  not 


224 : 


Diptheeia. 


found  Encouragement  to  use  vomiting  Physiek  in  any 
other  Case. 

“  The  internal  Ulcers  of  the  Throat  should  he  treated 
as  above  directed ;  but  if  there  be  a  great  Tumefac¬ 
tion  of  the  Glands,  I  order  externally  a  Plaister  of 
Diachylon  cum  Gummi  and  de  Panis  cum  Mercurio 
mixt ;  and  internally  the  following  Fumigation.  Take 
Wormwood,  Penny-royal,  the  Tops  of  St.  John’s  Wort, 
Camomile-Flowers  and  Elder-Flowers,  of  each  equal 
parts  ;  boil  very  strong  in  Water  ;  when  boil’d,  add  as 
much  Brandy  or  Bum  as  of  this  decoction  ;  steam  the 
Throat,  thro’  a  Tunnel,  as  hot  as  can  be  born,  three  or 
four  Times  a  Day. 

a  When  the  Lungs  are  seized  with  this  cankerous 
Crust ula,  which  is  indicated  by  the  Cough  and  Hoarse¬ 
ness  above  described,  Mercurial  Catharticks  frequently 
repeated  seem  the  best  of  any  Thing  to  promote  Ex¬ 
pectoration.  I  have  also  found  Success  in  the  Use  of 
the  Syrup  of  red  Poppies  and  Sperma  Ceti  mixt. 

“When  this  Distemper  appears  in  the  Form  of  an 
Erysipelas,  I  have  used  the  following  Fomentation 
with  good  Success.  Take  Wormwood,  Mint,  Elder- 
Flowers,  Camomile-Flowers,  the  Tops  of  St.  John’s 
Wort,  Fennel-Seeds  pounded,  and  the  lesser  Centaury, 
equal  Parts  ;  Infuse  in  good  Brandy  or  Jamaica  Bum, 
in  a  Stone- Jugg  well  stop’d,  and  keep  hot  by  the  Fire  : 
wet  a  Flannel  Cloth  with  this  ;  and  after  moderately 
squeezing  out  the  Liquor,  apply  three  or  four  double 
to  the  Tumor,  as  hot  as  can  be  born,  every  Hour.— In 
this  Case  I  repeat  Purging,  as  above  directed. 

“  As  for  the  external  Ulcers  above  described  (under 
the  4th  Head)  they  may  be  always  safely  and  speedily 
cured,  by  applying  once  or  twice  a  Day  a  good  thick 
Pledget  of  fine  Tow  dipt  in  the  above  described  vit 


Drug  Treatment. 


225 


riolick  water.  I  have  never  known  tliis  fail  in  a  single 
Instance,  when  seasonably  used.  But  then  it  must  be 
observed,  that  some  of  these  Ulcers  will  require  this 
Water  much  sharper  with  the  Yitriol,  than  others  will 
bear.  It  should  be  so  sharp  as  to  bring  off  the  Slough, 
dry  up  the  flow  of  corrosive  Humors,  and  promote  a 
Digestion  :  but  it  must  not  be  made  a  painful  Caus- 
tick.  In  this  the  Practitioner’s  Discretion  will  guide 
him. 

“  I  need  not  say  any  more  respecting  the  Bubo’s, 
mentioned  under  the  fifth  Head  :  but  that  they  must 
by  all  possible  Means  be  ripen’d  as  quick  as  they  can  ; 
and  launced  as  soon  as  they  are  digested  and  found  to 
contain  any  Pus. 

“  I  have  not  yet  found  any  effectual  Bemedy  in  the 
6th  and  last  Case  described. 

u  Upon  the  Disease  in  general,  I  have  made  the  fol¬ 
lowing  Remarks  ;  which  perhaps  may  be  of  some  Use. 

“  I  have  observ’d,  that  the  more  acute  the  Fever  is 
on  the  first  Seizure,  the  less  dangerous ;  because  there’s 
more  Hope  of  bringing  out  the  Eruptions. 

“  I  have  observ’d,  that  there’s  more  Danger  of  re¬ 
ceiving  Injury  from  a  cold  Air  in  this,  than  in  any 
eruptive  Fever  I  have  seen.  The  Eruptions  are  easily 
struck  in  ;  and  therefore  there  ought  to  be  all  possible 
Cave,  that  the  Sick  be  not  at  all  exposed  to  the  Air, 
till  the  Eruptions  are  quite  over  and  gone. 

“  I  have  also  observ’d,  that  there’s  much  greater 
Danger  from  this  disease  in  cold  Weather,  than  in  hot. 
In  cold  Weather  it  most  commonly  appears  in  the 
Form  described  under  the  second  Head  ;  while  on  the 
contrary,  a  hot  Season  very  much  forwards  the  Erup¬ 
tions. 

“  I  have  frequently  observ’d,  that  once  having  this 

10* 


226 


Dipthekia. 


Disease  is  no  Security  against  a  second  Attack.  I  have 
known  the  same  person  to  have  it  four  Times  in  one 
Year ;  the  last  of  which  prov’d  mortal.  I  have  known 
Numbers,  that  have  passed  thro’  it  in  the  eruptive 
Form  in  the  Summer  Season,  that  have  died  with  it 
the  succeeding  Fall  or  Winter  :  tho’  I  have  never  seen 
any  upon  whom  the  Eruptions  could  be  brought  out 
more  than  once. 

“  I  have  ordinarily  observ’d,  that  those  who  die 
with  this  Disease,  have  many  Purple-Spots  about 
them  ;  which  shews  the  Height  of  Malignity  and  Pes¬ 
tilential  Quality  in  this  terrible  Distemper. 

“  Thus,  Sir,  I  have  endeavor’d  in  the  most  plain  and 
familiar  Manner  to  answer  your  Demands.  I  have  not 
attempted  a  Philosophical  Inquiry  into  the  Nature  of 
this  Disease,  nor  a  Nation  ale  upon  the  Methods  of 
Cure.  I  have  meant  no  more  than  briefly  to  commu¬ 
nicate  to  you  some  of  my  Experiences  in  this  Distem¬ 
per,  which  I  presume  is  all  you  expect  from  me.  If 
this  proves  of  any  Service,  I  shall  have  Cause  of  Thank¬ 
fulness  :  If  not,  you’ll  kindly  accept  my  willingness  to 
serve  you,  and  to  contribute  what  I  can  towards  the 
Relief  of  the  afflicted  and  miserable.  I  am  Sir, 

“  Your  most  humble  Servant, 

“  Jonathan  Dickinson. 

“  Elizabethtown,  1ST.  Jersey,  Febr.  20,  1738,9. 

“  POSTSCRIPT. 

“  Since  I  wrote  this  Letter,  I  am  inform’d  by  a  Gen¬ 
tleman  of  the  Profession,  who  has  had  very  great  Im¬ 
provement  in  this  Distemper,  That  he  has  found  out  a 
Method  of  Cure,  which  seldom  fails  of  Success  in  all 
the  Forms  of  this  Disease  herein  described,  (the  first, 
fourth,  and  fifth  only  excepted,  which  should  be  treated 
as  above  directed)  and  that  is  a  Decoction  of  the  Root 


Hygienic  Treatment. 


227 


of  the  Dart  Weed,  or  (as  it  is  here  called)  the  Squaw 
Hoot.  He  orders  about  an  Ounce  of  this  Hoot  to  be 
boiled  in  a  Quart  of  Water,  to  which  he  adds  when 
strain’d  a  Jill  of  Rum  and  two  Ounces  of  Loaf-Sugar  ; 
and  boils  again  to  the  consumption  of  one  quarter 
Part.  This  he  gives  his  Patients  frequently  to  drink, 
and  with  this  orders  them  frequently  to  gargle  their 
Throats  ;  allowing  no  internal  Medicine  but  this  only, 
during  the  whole  Course  of  the  Disease,  excepting  a 
Purge  or  two  in  the  Conclusion.  I  have  seen  a  sur¬ 
prising  Effect  of  this  Method  in  one  Instance  ;  and 
shall  make  what  further  Observations  I  can :  And  if 
this  answers  my  present  Hopes,  I  shall  endeavor  to 
give  you  further  Information. 

“  The  Dart-Weed  grows  with  a  strait  stalk  six  or 
eight  Foot  high,  is  jointed  every  eight  or  ten  Inches 
apart ;  and  bears  a  large  white  Tassell  on  the  Top, 
when  in  the  Flower.  The  Root  is  black  and  bitterish.” 

HYGIENIC  TREATMENT  OF  DIPTIIERIA. 

Having  seen  what  merit  there  is  in  the  drug  treat¬ 
ment  of  diptheria,  and  what  reliance  can  be  placed  on 
the  theories  and  experience  of  medical  men,  who  be¬ 
lieve  in  a  system  which  is  in  opposition  to  Mature, 
contrary  to  common  sense,  and  in  direct  antagonism 
with  every  law  of  the  vital  organism,  let  us  now  pro¬ 
ceed  to  consider  the  rational  treatment  of  the  disease. 

As  I  have  already  explained,  diptheria  consists 
essentially  of  a  local  inflammation  and  a  general  fever. 
In  many  cases  the  throat  affection,  which  is  the  local 
inflammation,  is  slight,  while  the  constitutional  affec¬ 
tion,  or  general  fever,  is  severe  ;  and  in  other  cases  the 
reverse  happens — the  local  affection  being  severe  and 


228 


Diptheria. 


the  fever  slight.  The  fever  is  always  of  the  low, 
atonic,  and  typhoid  character.  The  local  inflammation, 
in  all  severe  cases,  is  attended  with  an  excretion  of 
coagulable  lymph,  which,  concreting  into  a  false  mem¬ 
brane,  forms  a  preternatural  crust  or  coating  to  the 
mucous  surface,  to  be  cast  off,  like  all  other  foreign 
or  abnormal  substances.  "When  spread  over  a  large 
portion  of  the  larynx,  trachea,  or  bronchial  ramifica¬ 
tions,  this  membranous  concretion  may  occasion  death 
by  suffocation.  In  the  other  cases  which  terminate 
fatally,  death  is  the  result  of  exhaustion. 

The  cause  of  diptheria  is  poison,  virus,  or  impurities 
of  some  kind  in  the  blood.  The  disease  itself  is  an 
effort  of  the  system  to  purify  itself  by  expelling  these 
impurities.  When  the  remedial  effort  is  chiefly  di¬ 
rected  to  the  surface,  there  will  be  much  constitutional 
disturbance  of  the  kind  denominated  fever.  If  the 
determination  to  the  surface  is  attended  with  consider¬ 
able  heat  and  dryness  of  the  skin,  it  may  be  mistaken 
for  high  or  sthenic  fever.  When  the  process  of  purifi¬ 
cation  is  determined  chiefly  to  the  mucous  membrane, 
there  will  be  corresponding  disturbance  of  the  function 
of  the  part,  and  of  the  character  which  medical  authors 
recognize  as  inflammation.  When  the  whole  mass  of 
blood  is  very  gross,  and  the  determination  to  the 
throat  very  violent,  ulceration  and  disorganization  of 
the  structure  follow  rapidly,  and  the  disease  takes  the 
name  of  “  putrid  sore  throat.”  In  many  cases  the 
process  of  depuration  is  very  nearly  equally  divided 
between  the  skin  and  mucous  membrane,  in  which 
case  the.  life  of  the  patient  usually  depends  on  the 
kind  of  medication — whether  it  increases  the  determin¬ 
ation  to  or  from  the  external  surface.  Medicines  may 
be  employed  whi’ch  do  not  materially  unbalance  nor 


Hygienic  Treatment. 


229 


derange  the  existing  remedial  effort,  and  although 
they  are  really  a  damage  to  the  patient,  and  prolong 
the  convalescence,  yet  because  they  are  not  apprecia¬ 
bly  mischievous  at  the  moment,  they  may  get  the 
credit  of  curing  the  disease. 

When  the  remedial  struggle  is  nearly  balanced,  or 
directed  chiefly  to  the  external  surface,  there  is  very 
little  danger,  and  such  cases  seldom  terminate  fatally, 
except  as  death  is  the  result  of  maltreatment.  The 
danger  results  from  the  concentration  of  morbid  action 
to  a  particular  point,  thus  disorganizing  and  destroying 
the  tissue  ;  hence  the  danger  may  be  measured,  as  a 
general  rule,  by  the  violence  of  the  throat-affection. 
There  are  cases,  however,  in  which  the  system  is  so 
gross,  the  blood  so  impure,  and  all  the  fluids  so  foul, 
that  before  the  remedial  effort  has  become  established 
in  the  direction  of  any  outlet,  the  patient  will  sink  and 
die  of  exhaustion,  with  very  slight  manifestations  of 
general  fever  or  of  local  inflammation. 

When  the  patient  is  blessed  with  a  good  constitu¬ 
tion,  and  his  habits  of  living  and  exposure  to  infection 
are  not  such  as  to  render  his  blood  and  secretions 
greatly  depraved,  the  remedial  effort — the  process  of 
purification — will  be  so  equally  balanced  and  so  well 
maintained,  that  he  will  bear  a  great  amount  of  inju¬ 
rious  treatment,  and  endure  a  hundred  doses  of  drug 
poisons,  without  losing  his  life.  But  if,  on  the  con¬ 
trary,  the  constitution  is  very  frail  or  very  gross,  so 
that  the  morbid  action  is  directed  wholly  from  the 
surface,  a  small  bleeding,  a  single  leech,  a  blister,  a 
cathartic  dose,  a  mercurial  purge,  or  an  antimonial 
emetic,  or  a  single  touch  of  the  burning  caustic,  may 
decide  the  case  against  the  patient  in  a  few  hours. 

The  danger  of  diptheria  results,  usually,  from  the 


230 


Dipthekia. 


excessive  determination  of  morbid  action  to  tire  throat ; 
and,  hence,  the  obvious  indication  of  cure  is  to  coun¬ 
teract  this  determination  by  promoting  depuration  in 
other  directions,  especial] y  through  the  skin.  By 
counteracting  this  determination  of  morbid  action,  or 
of  remedial  effort — for,  however  strange  the  language 
may  seem  to  persons  unaccustomed  to  it,  these  phrases 
really  mean  the  same  thing — I  do  not  mean  repressing 
or  subduing  it,  but  regulating  it. 

And  here  is  the  great  principle  which  underlies  all 
correct  medication,  and  which  forms  the  broad  dis¬ 
tinction  between  Hygienic  and  Drug  Treatment.  I 
do  not  look  upon  disease  as  a  thing  to  be  u  subdued,” 
“  suppressed,”  u  destroyed,”  “  expelled,”  or  extermin¬ 
ated.  It  is  an  action  to  be  regulated.  To  regulate 
remedial  effort,  or  morbid  action,  is  simply  so  to  con¬ 
trol  and  direct  it  that  each  organ  or  part  may  perform 
its  own  appropriate  duty,  to  the  end  that  no  structure 
may  be  disorganized  by  having  too  great  a  burden 
thrown  upon  it.  Instead  of  subduing  disease  by 
merely  opposing  or  counteracting  the  symptoms,  the 
proper  business  of  the  physician  is  so  to  diffuse,  direct, 
and  equalize  it,  that  it  may  successfully  accomplish  its 
work  of  purification. 

The  first  indication,  then,  in  the  treatment  of  dip- 
theria,  is  to  bcdance  the  circulation ,  and  in  fulfilling 
this  indication  the  temperature  of  the  body  is  the  prop¬ 
er  and  the  infallible  guide.  Wherever  there  is  de¬ 
ficient  circulation  there  are  coldness  and  paleness,  and 
wherever  there  is  congestion  or  obstruction  there  are 
pain,  heat,  and  disturbed  function  ;  and  these  condi¬ 
tions  must  ever  be  kept  in  mind,  as  they  are  the  basis 
of  all  proper  therapeutic  applications  and  processes. 

We  have  seen  that  the  disease  may  be  attended  with 


Hygienic  Treatment. 


231 


all  grades  and  shades  of  typhoid  fever,  and  with  all  de¬ 
grees  of  atonic  local  inflammation.  The  constitutional 
disturbance  which  we  denominate  fever,  may  he  at¬ 
tended  with  much  or  little  preternatural  heat  of  the 
surface,  or  with  none  at  all ;  or  with  a  temperature  be¬ 
low  the  normal  standard ;  or  with  irregular  tempera¬ 
ture — some  parts  of  the  surface  being  above  and  others 
below  the  normal  standard. 

The  general  remedial  plan,  therefore,  so  far  as  the 
fever  is  concerned,  is  resolved  into  the  simple  idea  of 
regulating  the  temperature.  To  do  this  is  to  promote 
equal  distribution  of  the  blood,  in  other  words,  to 
balance  the  circulation  ;  and  as  functional  action  is 
always  in  proportion  to  the  vigor  of  the  circulation,  so 
by  regulating  the  temperature  and  balancing  the  cir¬ 
culation,  we  supply  the  conditions  which  enable  “  Na¬ 
ture”  to  cure  the  disease  ;  or,  in  less  figurative  phrase- 
ology,  which  aid  and  assist  the  living  system  to  do  its 
work  of  purification. 

The  cure  of  disease  consists  in  removing  the  causes  / 
not  in  silencing  the  remedial  struggle  j  for  this  is  but 
hilling  the  patient. 

If  these  views  are  correct — and  no  medical  man  will 
ever  seriously  controvert  them — it  is  easy  to  under¬ 
stand  how  it  is,  and  why  it  is,  that  a  bleeding,  or  a 
blister,  or  a  dose  of  Epsom  salts,  or  an  antiphlogistic 
operation  of  niter,  antimony,  colchicum,  digitalis,  ac¬ 
onite,  or  veratria  may  quickly  extinguish  the  patient’s 
lamp  of  life,  by  concentrating  remedial  action  in  the 
center  of  the  vital  domain,  when  all  of  the  living  en¬ 
ergies  are  needed  to  determine  the  morbid  matter  to 
the  surface. 

They  show,  too,  the  great  delusion  of  the  medical 
profession,  in  relying  on  stimulants  or  antiphlogistics 


232 


Diptheria. 


to  promote  action  to  or  from  the  surface.  All  that 
these  agents  do,  or  can  do,  is  to  occasion  or  aggravate 
a  fever,  or  induce  or  aggravate  a  local  inflammation, 
thus  adding  to  the  causes  of  disease,  and  necessitating 
a  waste  of  vital  power  to  get  rid  of  them. 

Nature  does  not  own,  and  the  living  system  abhors 
this  whole  plan — though  it  be  the  plan  of  the  whole 
medical  profession — of  “  curing  a  primary  disease  by 
creating  a  drug  disease.” 

To  balance  the  circulation,  regulate  the  temperature, 
promote  external  depuration,  and  remove  congestion 
and  obstruction,  we  do  not  need  the  inflaming  stimu¬ 
lants,  the  corroding  caustics,  the  paralyzing  narcotics, 
nor  the  deadly  antiphlogistics.  We  have  in  water 
alone  all  that  is  usable  or  useful  for  the  purpose  indi¬ 
cated.  It  may  be  employed  of  any  temperature  from 
ice  to  steam,  according  to  the  circumstances  of  any 
given  case.  Water  is  the  sole  vehicle  by  means  of 
which  all  of  the  nutrient  materials  of  the  body  are 
transported  to  the  various  structures,  by  which  all  of 
the  effete  materials  or  waste  matters  of  the  body  are 
carried  to  the  various  outlets,  and  is  also  the  material 
by  which  the  temperature  of  the  system  is  properly 
radiated,  balanced,  maintained,  and  regulated.  There 
is  nothing  provided  in  the  universe  that  can  subserve 
these  purposes  except  water.  And  if  it  plays  so  im¬ 
portant  a  part  in  the  normal  exercise  of  the  functions, 
it  becomes  even  more  necessary,  if  possible,  in  their 
abnormal  exercise — the  state  of  disease — when  there  is 
extra  and  unusual  duty  to  perform. 

In  the  state  of  health,  and  under  all  the  ordinary 
circumstances  of  life,  the  temperature  of  the  body  is 
easily  regulated,  and  the  circulation  balanced,  so  that 
disease  is  prevented ,  by  means  of  air,  exercise,  cloth- 


Hygienic  Treatment. 


233 


ing,  and  artificial  heat.  In  health  the  external  use  of 
water  is  often  refreshing  and  invigorating,  and  condu¬ 
cive  to  longevity;  but  in  disease  it  becomes  a  necessity. 
In  disease  there  are  venoms,  viruses,  poisons,  or  accu¬ 
mulated  impurities  of  some  kind,  to  be  diluted  and 
washed  away ;  and  this  calls  for  a  more  free  use  of 
water  internally  than  is  demanded  in  the  state  of 
health.  And  as  the  solvent  and  detergent  properties 
of  water  are  in  the  direct  ratio  of  its  purity,  how  ab¬ 
surd  is  the  practice  of  medicating  the  water — whether 
it  is  to  be  employed  externally  to  regulate  tempera¬ 
ture,  or  internally  to  cleanse  the  system  of  noxious 
matters — with  mustard,  vinegar,  saleratus,  salt,  ashes, 
spirits,  roots,  herbs,  barks,  leaves,  flowers,  seeds !  etc. 
Although  these  foreign  substances  do  not  in  all  cases 
prevent  the  water  from  having  some  degree  of  benefi¬ 
cial  effect,  they  always  diminish  its  value  in  proportion 
to  their  quantity.  There  would  be  just  as  much  sense, 
reason,  or  science  in  taking  the  impure  water  of  the 
ocean  to  cook  victuals  or  wash  clothes  with,  as  to  em¬ 
ploy  water  holding  in  solution  mineral,  earthy,  or  al¬ 
kaline  ingredients  to  cleanse  the  solids  and  purify  the 
fluids  of  the  living  system. 

It  is  true  that  there  are  persons  who  call  themselves 
“  Hydropathic5’  physicians,  and  who  are  the  proprie¬ 
tors  of  what  they  advertise  as  “Water-Cure”  estab¬ 
lishments,  who  recommend  and  prescribe  “  mineral 
waters but  I  could  never  understand  why  the 
poisons  or  impurities  taken  from  “  medicinal  springs” 
are  so  different  from  the  same  poisons  or  impurities 
obtained  at  the  apothecary  shop. 

Before  proceeding  to  explain  the  proper  treatment  for 
diptheria,  I  will,  in  order  to  save  repetition,  copy  from 
a  small  work  I  have  published — “Water-Cure  for  the 


234 


Diptheeia. 


Million,”  a  description  of  the  various  bathing  processes, 
so  far  as  they  may  be  applicable  to  home-treatment : 

“  1.  Wet-Sheet  Packing. — On  a  bed  or  mattress 
two  or  three  comfortables  or  bed-quilts  are  spread  ; 
over  them  a  pair  of  flannel  blankets  ;  and  lastly,  a  wet 
sheet  (rather  coarse  linen  is  best)  wrung  out  lightly. 
The  patient,  undressed,  lies  down  flat  on  the  back,  and 
is  quickly  enveloped  in  the  sheet,  blanket,  and  other 
bedding.  The  head  must  be  well  raised  with  pillows, 
and  care  must  be  taken  to  have  the  feet  well  wrapped. 
If  the  feet  do  not  warm  with  the  rest  of  the  body,  a 
jug  of  hot  water  should  be  applied;  and  if  there  is 
tendency  to  headache,  several  folds  of  a  cold  wet  cloth 
should  be  laid  over  the  forehead.  The  usual  time  for 
remaining  in  the  pack  is  from  forty  to  sixty  minutes. 
It  may  be  followed  by  the  plunge,  half-bath,  rubbing 
wet  sheet,  or  towel-wash,  according  to  circumstances. 
The  pack  is  not  intended  as  a  sweating  process,  as 
many  suppose,  though  a  moderate  perspiration  is  not 
objectionable.  A  comfortable  temperature  of  the  sur¬ 
face  is  the  desideratum,  independent  of  more  or  less 
sweating,  or  none  at  all.  When  the  patient  warms  up 
rapidly,  thirty  minutes  or  less  will  be  long  enough  to 
remain  enveloped  ;  but  when  he  becomes  warm  slowly 
and  with  difficulty,  an  hour,  or  more,  is  not  too  long. 
In  some  cases  it  is  necessary  to  put  hot  bottles  to  the 
sides  as  well  as  to  the  feet.  When  the  object  is  to  cool 
a  fever,  the  sheet  should  be  allowed  to  retain  more 
water,  or  if  the  skin  is  very  hot,  double  sheets  may  be 
used.  In  chronic  diseases,  when  the  main  object  is  to 
induce  ‘  reaction,5  or  rather  circulation,  toward  the 
surface,  the  sheet  should  be  wrung  more  thoroughly, 
and  the  patient  enveloped  with  a  greater  quantity  of 
blankets,  comfortables,  or  other  bedding. 


Hygienic  Treatment. 


235 


u  2.  Hale-Pack. — This  is  the  same  as  the  preceding, 
with  the  exception  that  the  neck  and  extremities  are 
not  covered  by  the  wet  sheet,  which  is  applied  merely 
to  the  trunk  of  the  body,  from  the  armpits  to  the  hips. 
It  is  adapted  to  those  whose  circulation  is  too  feeble 
for  a  full  pack  ;  it  is  also  often  employed  as  a  prepara¬ 
tion  for  the  fall  pack. 

“  3.  Half-Bath. — An  oval  or  oblong  tub  is  most 
convenient,  though  any  vessel  allowing  a  patient  to  sit 
down  with  the  legs  extended  will  answer.  The  water 
should  cover  the  lower  extremities  and  about  half  of 
the  abdomen.  While  in  the  bath,  the  patient,  if  able, 
should  rub  the  lower  extremities,  while  the  attendant 
rubs  the  chest,  back,  and  abdomen. 

“  4.  Hip  or  Sitz-Bath. — Any  small-sized  wash-tub 
will  do  for  this,  although  tubs  constructed  with  a 
straight  back,  and  raised  four  or  five  inches  from  the 
floor,  are  much  the  most  agreeable.  The  water  should 
just  cover  the  hips  and  lower  part  of  the  abdomen. 
A  blanket  should  be  thrown  over  the  patient,  who  will 
find  it  also  useful  to  rub  or  knead  the  abdomen  with 
the  hand  or  fingers  during  the  bath. 

“  5.  Foot-Bath. — Any  small  vessel,  as  a  pail,  will 
answer.  Usually  the  water  should  be  about  ankle- 
deep  ;  but  very  delicate  invalids,  or  extremely  suscep¬ 
tible  persons  should  not  have  the  water  more  than 
half  an  inch  to  one  inch  in  depth.  During  the  bath, 
the  feet  should  be  kept  in  gentle  motion.  Walking 
foot-baths  are  excellent  in  warm  weather,  where  a  cool 
stream  can  be  found. 

“  6.  Wet  and  Cold  Foot-Bath. — Place  the  feet  in 
water  as  warm  as  can  be  borne  for  five  to  ten  minutes  ; 
then  dip  them  for  a  moment  in  cold  water,  and  wipe 
dry. 


236 


Diptheria. 


“  7.  Rubbing  Wet-Sheet. — If  the  sheet  is  used  drip 
jpingly  wet,  the  patient  stands  in  the  tub  ;  if  wrung  so 
as  not  to  drip,  it  may  he  used  on  a  carpet  or  in  any 
place.  The  sheet  is  thrown  around  the  body,  which  it 
completely  envelops  below  the  neck  ;  the  attendant 
rubs  the  body  over  the  sheet  (not  with  it),  the  patient 
exercising  himself  at  the  same  time  by  rubbing  in  front. 

“  8.  Pail-Douche.  —  This  means  simply  pouring 
water  over  the  chest  and  shoulders  from  a  pail. 

“  9.  Stream-Douche. — A  stream  of  water  may  be 
applied  to  the  part  or  parts  affected,  by  pouring  from 
a  pitcher  or  other  convenient  vessel,  held  as  high  as 
possible  ;  or  a  barrel  or  keg  may  be  elevated  for  the 
purpose,  having  a  tub  of  any  desired  size.  The  power 
will  be  proportional  to  the  amount  of  water  in  the 
reservoir. 

“  10.  Towel  or  Sponge  Bath. — Rubbing  the  whole 
surface  with  a  coarse  wet  towel  or  sponge,  followed  by 
a  dry  sheet  or  towels,  constitutes  this  process. 

“  11.  Affusion  Bath. — This  implies  pouring  water 
gently  over  the  surface  of  the  body.  The  patient  may 
stand  in  a  tub,  or  lie  on  the  bed,  the  bedding  being 
protected  by  a  sheet  of  India-rubber  or  gutta-percha. 

“  12.  The  Blhnge-Batii. — This  is  employed  but 
little,  except  at  the  establishments.  Those  who  have 
conveniences  will  often  find  it  one  of  the  best  pro¬ 
cesses.  Any  tub  or  box  holding  water  enough  to 
allow  the  whole  body  to  be  immersed,*  with  the  limhs 
extended,  answers  the  purpose.  A  very  good  plunge 
can  be  made  of  a  large  cask  cut  in  two  near  the  mid¬ 
dle.  It  is  a  useful  precaution  to  wet  the  head  before 
taking  this  bath. 

“  13.  Drop-Bath.' — A  vessel,  filled  with  very  cold 
water,  is  furnished  with  a  small  aperture  through 


Hygienic  Treatment. 


237 


which  the  water  falls  in  drops.  It  is  adapted  to  torpid 
muscles,  paralytic  limbs,  tumors,  etc.  It  should  be 
followed  by  active  friction. 

“14.  The  Sweating -Pack. — To  produce  perspiration, 
the  patient  is  packed  in  the  flannel  blanket  and  other 
bedding,  as  mentioned  in  Ho.  1,  omitting  the  wet 
sheet.  Some  persons  will  perspire  in  less  than  an 
hour ;  others  require  several  hours.  This  is  the  se¬ 
verest  of  the  Water-Cure  processes,  and,  in  fact,  is 
very  seldom  called  for.  The  warm,  -  hot,  or  vapor- 
baths  are,  in  most  cases,  preferable. 

“  15.  IIead-Bath, — The  patient  lies  extended  on  a 
rug  or  mattress,  the  head  resting  in  a  shallow  basin  or 
bowl,  holding  two  or  three  inches  of  water,  the  shoul¬ 
ders  being  supported  by  a  pillow.  It  is  principally 
employed  in  chronic  affections  of  the  head,  eyes,  and 
ears.  Wet  cloths  applied  to  the  head,  the  “pouring- 
bath,”  and  the  “wet  cap”  are  good  substitutes. 

“16.  The  Pouring  TIead-Batii.— The  patient  lies 
face  downward,  the  head  supported  by  an  attendant, 
projecting  over  the  side  of  the  bed,  which  is  protect¬ 
ed  by  a  sheet  or  blanket  thrown  around  the  patient’s 
neck  ;  a  tub  is  placed  under  the  head  to  catch  the  water, 
which  is  poured  from  a  pitcher  moderately,  but  stead¬ 
ily,  for  several  minutes,  or  until  the  head  is  well  cooled, 
the  stream  being  principally  applied  to  the  temples  and 
back  part  of  the  head.  It  is  useful  in  severe  cases  of 
sick  headache;  in  the  early  stage  of  violent  choleras ; 
in  the  early  stages  of  fevers,  when  attended  with  great 
gastric  irritation  or  biliary  disturbance.  In  hysteria, 
apoplexy,  delirium- tremens,  nose-bleeding,  inflamma¬ 
tion  of  the  brain,  ophthalmia,  otitis,  etc.,  it  has  been 
employed  with  advantage. 

“  17.  Fountain,  or  Spray-Bath. — This  consists  of  a 


238 


Diptiieria. 


number  of  small  streams  of  water  directed  to  a  partic¬ 
ular  part  of  the  body.  It  may  be  regarded  as  a  gen¬ 
tle  douche  or  local  shower.  It  is  intended  to  excite 
action  and  promote  absorption  in  the  part  or  organ  to 
which  it  is  applied. 

“  18.  The  Shower-Bath. — This  needs  no  descrip¬ 
tion.  It  is  not  frequently  used  in  Water-Cure,  but  is 
often  very  convenient.  Those  liable  to  a  “  rush  of 
blood  to  the  head,”  should  not  allow  much  of  the 
shock  of  the  stream  upon  the  head.  Feeble  persons 
should  never  use  this  bath  until  prepared  by  other 
treatment.  Placing  the  feet  for  a  few  minutes  in 
warm  water,  before  taking  the  shower,  is  a  good  pre¬ 
paratory  measure  for  feeble  persons.  Standing  in 
warm  water,  ankle  deep,  will  materially  lessen  its 
shock  on  the  brain  and  nervous  system. 

“  19.  Nasal,  Mouth,  and  Eye  Baths. — Drawing 
water  gently  up  the  nostrils  and  ejecting  it  by  the 
mouth,  holding  water  in  the  mouth,  and  holding  the 
eyes  open  in  water  of  a  temperature  suited  to  the  case, 
are  the  processes  indicated  by  these  terms.  They  are 
useful  in  relaxed  and  inflammatory  affections  of  the 
mucous  membranes  and  other  structures  of  the  parts. 

“  20.  Arm  and  Leg  Baths. — The  limbs  may  be  held 
in  any  convenient  vessel  containing  the  requisite  depth 
of  water.  These  baths  are  useful  in  cases  of  fever 
sores,  chronic  ulcers,  inflammatory  affections  of  the 
joints,  etc. 

“  21.  Vapor-Bath. — Hot  stones  or  bricks  may  be 
employed  to  generate  vapor  or  steam.  The  patient 
may  sit  naked  on  an  open-work  chair,  with  blankets 
pinned  around  the  neck  ;  a  small  tub  or  a  common 
tin  pan,  holding  a  quart  of  water,  is  placed  under  the 
chair,  and  red-hot  bricks  or  stones  occasionally  put  in 


Hygienic  Treatment. 


239 


the  vessel,  so  as  to  keep  the  vapor  constantly  rising 
from  the  surface  of  the  water.  Another  very  simple 
plan  is  this :  Procure  a,  one-gallon  tin  boiler,  with  a 
half-inch  tin  pipe,  having  two  or  three  joints  and  a 
single  elbow.  The  boiler  may  be  heated  on  any  ordi¬ 
nary  stove,  grate,  or  furnace,  and  the  pipe  so  attached 
to  it  as  to  convey  the  steam  under  the  chair  in  which 
the  patient  sits,  covered  from  the  neck  downward  with 
blankets.  It  may  be  employed  from  ten  to  thirty  min¬ 
utes,  according  to  the  amount  of  vapor  generated. 

“  22.  Air-Bath. — The  whole  body  is  suddenly  ex¬ 
posed  to  cool  or  cold  air,  or  even  to  a  strong  current, 
and  an  excellent  and  invigorating  process  it  is  in  many 
cases.  There  is  no  danger  from  it,  provided  the  sur¬ 
face  has  a  comfortable  glow  or  temperature  at  the  time, 
and  the  circulation  is  maintained  by  active  exercise. 
Friction  with  the  hand,  a  sheet,  towel,  or  flesh-brush, 
is  beneficial  at  the  same  time. 

“  23.  Bandages  and  Compresses. — These  are  wet 
cloths,  applied  to  any  weak,  sore,  hot,  painful,  or  dis¬ 
eased  part,  and  renewed  so  often  as  they  become  dry  or 
very  warm.  The  best  surgeons  have,  in  all  ages,  em¬ 
ployed  ‘  water-dressings’  alone  in  local  wounds,  injuries, 
and  inflammations.  They  may  be  warming  or  cooling 
to  the  part,  as  they  are  covered,  or  not,  with  dry  cloths. 

“  24.  The  Wet-Girdle. — Three  or  four  yards  of 
crash  toweling  make  a  good  one.  One  half  of  it  is 
wet  and  applied  around  the  abdomen,  followed  by  the 
dry  half  to  cover  it.  It  should  be  wetted  so  often  as  it 
becomes  dry.  It  is  extensively  employed  in  bilious 
and  dyspeptic  affections,  female  weaknesses,  etc. 
When  required  to  be  worn  for  a  long  time,  it  should, 
after  the  first  few  weeks,  be  omitted  occasionally,  or 
worn  only  a  part  of  each  day,  so  that  the  skin  over 


240 


Diptheria. 


which  it  is  applied  will  not  become  too  tender.  It 
should  not  be  worn  when  it  occasions  permanent  chil¬ 
liness. 

“  25.  Tiie  Chest- Wrapper. — This  is  made  of  coarse 
linen,  to  fit  the  trunk  like  an  under-shirt,  from  the 
neck  to  the  lower  ribs  ;  it  is  applied  so  wet  as  possible 
without  dripping,  and  covered  by  a  similar  dry  wrap¬ 
per,  made  of  Canton  or  light  woolen  flannel.  It  re¬ 
quires  renewing  two  or  three  times  a  day.  It  is  useful 
in  most  cases  of  pneumonia,  asthma,  consumption, 
bronchitis,  etc.  The  same  precautions  apply  to  its 
prolonged  employment  as  mentioned  under  the  head 
of  the  wet-girdle. 

“  26.  Fomentations. — These  are  employed  for  relax¬ 
ing  muscles,  relieving  spasms,  griping,  nervous  head¬ 
ache,  etc.  Any  cloths  wet  in  hot  water  and  applied  so 
warm  as  can  be  borne,  generally  answer  the  purpose  ; 
but  flannel  cloths  dipped  in  hot  water,  and  wrung 
nearly  dry  in  another  cloth  or  handkerchief,  so  as  to 
steam  the  part  moderately,  are  the  most  efficient  seda¬ 
tives.  They  are  usually  employed  from  five  to  fifteen 
minutes.  They  are  useful  in  cases  of  severe  constipa¬ 
tions,  colic,  dysmenorrhea,  hysteria,  etc. 

“  27.  Refrigeration. — One  part  of  common  salt  to 
two  parts  of  snow  or  pounded  ice  makes  a  good  freez¬ 
ing  mixture.  It  is  inclosed  in  a  very  thin  cloth,  and 
applied  for  a  few  minutes,  until  the  requisite  degree 
of  congelation  has  taken  place.  It  is  useful  in  felons, 
styes,  malignant  tumors  and  ulcers,  fever  sores,  can¬ 
cers,  and  in  some  forms  of  neuralgia  and  rheumatism. 

“  28.  Wet  Dress  Bath. — This  is  a  method  of  self¬ 
packing,  enabling  the  patient  to  dispense  with  the 
services  of  an  attendant.  A  linen  sheet  is  fashioned 
into  the  form  of  a  night-dress,  with  large  sleeves,  and 


Hygienic  Treatment. 


241 


after  the  bed  is  prepared,  the  dress  can  he  wet  and  put 
on  ;  the  patient  can  then  get  into  bed  and  wrap  him¬ 
self  sufficiently  to  secure  a  comfortable  reaction. 

“  29.  Electro- Chemical  Bath.  ■ —  A  copper-lined 
bath-tub  is  necessary  for  this  process.  The  patient  is 
immersed  in  warm  water  up  to  the  neck  ;  one  hand  is 
brought  in  contact  with  the  positive  pole  of  a  strong 
galvanic  battery,  the  negative  pole  being  in  contact 
with  the  metallic  lining  of  the  tub.  The  water  is  usu¬ 
ally  acidulated,  though  in  some  cases  alkalies  are  em¬ 
ployed.  From  half  a  pint  to  a  pint  of  nitric  acid  is 
put  into  the  water  for  each  bath.  It  should  not  be 
mixed  with  the  water  until  the  galvanic  circuit  is  com¬ 
pleted,  either  by  having  the  patient  in  connection  with 
the  poles  of  the  battery,  or  these  in  contact  with  the 
copper-lining  of  the  bath-tub.  The  patient  may  re¬ 
main  in  the  bath  from  ten  minutes  to  half  an  hour. 
This  bath  is  very  useful  in  a  torpid  condition  of  the 
skin  with  low  circulation  ;  in  glandular  obstructions ; 
scrofulas,  rheumatic  and  gouty  affections  ;  in  chronic 
congestions  of  the  liver,  and  to  aid  the  elimination  of 
mineral  medicines  and  other  poisons. 

“  30.  Injections.— -These  are  warm  or  tepid,  cool  or 
cold.  The  former  are  used  to  quiet  pain  and  produce 
free  discharges  ;  the  latter  to  check  excessive  evacua¬ 
tions  and  strengthen  the  bowels.  For  the  former  pur¬ 
pose  so  large  a  quantity  should  be  used  as  the  bowels 
can  conveniently  receive ;  and  for  the  latter  purpose 
only  a  small  quantity — so  much  as  can  be  conveniently 
retained.  Small  enemas  of  very  cold  water  are  highly 
serviceable  in  cases  of  piles,  prolapsus,  fissures,  etc. 
The  self-injecting  syringe  is  the  most  convenient  in¬ 
strument.  With  a  rectal,  vaginal,  and  intra-uterine 
tube,  it  will  answer  all  possible  purposes,  for  old  or 

11 


242 


Diptheeia. 


young,  male  or  female.  These  articles  can  all  be  fur-  _ 
nished  for  $3. 

“  31.  Geneeal  Batiiixg  Rules. — Never  bathe  soon 
after  eating.  The  most  powerful  baths  should  be  taken 
when  the  stomach  is  most  empty.  No  full  bath  should 
be  taken  less  than  three  hours  after  a  full  meal.  Great 
heat  or  profuse  perspiration  are  no  objections  to  going 
into  cold  water,  provided  the  respiration  is  not  dis¬ 
turbed,  and  the  patient  is  not  greatly  fatigued  or  ex¬ 
hausted.  The  body  should  always  be  comfortably 
warm  at  the  time  of  taking  any  cold  bath.  Exercise, 
friction,  dry-wrapping,  or  lire  may  be  resorted  to,  ac¬ 
cording  to  circumstances.  Very  feeble  persons  should  ' 
commence  treatment  with  warm  or  tepid  water,  gradu¬ 
ally  lowering  the  temperature.  All  shocks,  such  as 
shower-baths,  douches,  plunges,  etc.,  should  be  avoided 
by  every  feeble  and  irritable  invalid  ;  by  consumptives 
in  the  second  and  later  stages;  by  those  who  are  liable 
to  great  local  determinations,  or  congestions,  as  “  rush 
of  blood  to  the  head, 55  bleeding  from  the  stomach  or 
lungs,  etc.  ;  in  displacements  of  the  bowels  or  uterus  ; 
during  the  menstrual  period  of  females ;  during  any 
considerable  crisis  or  critical  effort ;  after  the  crisis  or 
“  turn”  of  any  fever,  or  other  acute  disease;  during 
the  existence  of  any  powerful  emotion  or  excitement ; 
soon  after  eating  or  copious  drinking ;  in  all  cases  at¬ 
tended  with  profuse  discharges,  as  diarrhea,  cholera, 
diabetes,  hemorrhages ;  during  the  suppurative  stage 
of  extensive  abscesses  or  ulcers.  The  heat  or  feverish¬ 
ness  which  may  attend  any  of  the  conditions  or  dis¬ 
eases  above-named  should  always  be  abated  by  tepid 
effusions  or  spongings.  It  is  dangerous  to  employ  the 
wet-sheet  pack,  in  prolonged  or  violent  fevers,  after 
the  crisis  or  turn  of  the  fever.  Many  errors  have  been 


Hygienic  Treatment. 


243 


committed  in  ignorance  of  this  rule.  Mever  eat  imme¬ 
diately  after  bathing. 

“  32.  Duration  of  Baths. — Many  errors  are  com¬ 
mitted  by  remaining  in  cold  baths  for  too  long  a  time. 
I  have  known  cases  in  which  dyspeptics  and  consump¬ 
tives,  at  Water-Cure  establishments,  were  kept  in  cold 
sitz-baths  for  two  hours  at  a  time,  once  or  twice  a  day. 
This  was  intended  as  a  derivative  measure,  but  it 
worked  very  injuriously  for  the  patients.  Derivative 
baths,  like  all  others,  must  be  determined  by  the  con¬ 
dition  of  the  patient,  not  by  the  thermometer  nor  chro¬ 
nometer.  Sitz-baths  of  a  mild  temperature  should  sel¬ 
dom  be  prolonged  beyond  twenty  minutes  ;  more  fre¬ 
quently  ten  to  fifteen  minutes  are  preferable.  It  is 
better  to  repeat  all  bathing  appliances  frequently,  than 
to  make  violent  impressions  less  frequently.  Plunges, 
douches,  and  showers,  if  the  water  is  cold  or  cool, 
should  not  ordinarily  be  continued  more  than  a  min¬ 
ute  ;  when  the  temperature  of  the  water  is  temperate, 
or  tepid,  they  may  be  taken  from  five  to  ten  minutes. 
Tepid  half-baths  should  usually  be  taken  from  five  to 
ten  minutes.  Sitz-baths,  foot-baths,  head-baths,  arm 
and  leg  baths,  etc.,  may  vary  from  five  to  thirty  min¬ 
utes.  But,  as  already  intimated,  regard  must  always 
be  had  to  the  temperature  of  the  water  and  the  circu¬ 
lation  of  the  patient.” 

In  the  premonitory  stage  of  diptheria,  when  the  pa¬ 
tient  is  affected  with  rigors  or  chilliness,  or  these  with 
alternate  and  irregular  flushes  of  heat,  a  full  warm 
bath,  as  warm  as  the  patient  can  comfortably  bear,  for 
ten  or  fifteen  minutes,  should  be  employed  if  practica¬ 
ble.  If  this  is  impracticable,  the  warm  hip-bath  and 
the  hot  foot-bath  are  the  best  substitutes.  If  these  are 
not  available,  warm  fomentations  to  the  abdomen,  and 


244: 


Diptiieria. 


bottles  of  hot  water  to  the  sides  and  feet,  should  be  re¬ 
sorted  to. 

If  there  is  at  this  time  pain  or  soreness  of  the  throat 
without  much  heat,  fomentations  should  be  applied 
externally  for  ten  or  fifteen  minutes,  followed  by 
the  cold  wet  compress  covered  with  a  dry  towel  or 
cloth  ;  and  this  should  be  re-wet  and  re-applied  as 
often  as  it  becomes  warm  or  nearly  dry.  The  patient 
should  keep  entirely  quiet  at  this  time,  avoiding  every¬ 
thing  in  the  shape  of  food,  condiments,  stimulants,  and 
medicines,  swallowing  nothing  but  pure  water,  and  of 
this  only  so  much  as  is  demanded  by  the  thirst.  The 
temperature  of  the  water  for  drinking  may  be  that 
which  is  most  agreeable  to  the  patient. 

When  the  hot  stage  of  the  fever  is  fully  developed, 
the  tepid  half-bath,  the  tepid  ablution,  or  the  wet-sheet 
pack  may  be  resorted  to.  The  wet-sheet  pack  is  best 
adapted  to  those  cases  in  which  the  heat  and  dryness 
are  uniform  over  the  whole  surface,  and  the  patient  is 
not  greatly  prostrated.  But  with  more  feeble  patients, 
and  when  the  external  heat  is  moderate  or  unequal, 
the  tepid  ablution  should  be  preferred.  The  tepid 
half-bath  is  applicable  to  the  same  cases  as  the  wet- 
sheet,  and  is  only  preferable  when  the  attendants  do 
not  well  understand  the  management  of  the  packing 
process.  The  temperature  of  the  water  should  be  cool, 
but  not  very  cold — from  Yo°  to  85°  Fahrenheit.  Either 
of  the  baths  may  be  repeated  as  often  as  occasion  re¬ 
quires  ;  that  is,  as  often  as  the  external  temperature  of 
the  patient  rises  much  above  the  normal  standard. 
The  patient  should  be  put  to  bed  immediately  after 
each  bath  and  kept  warm  and  comfortable ;  much 
sweating,  however,  is  to  be  avoided,  although  a  very 
moderate  perspiration  may  be  desirable.  Too  much 


Hygienic  Treatment. 


245 


care  can  not  be  taken  to  keep  the  feet  warm  and  tlie 
head  cool ;  and  if  there  is  the  least  tendency  to  cold¬ 
ness  of  the  lower  extremities  and  heat  of  the  head,  hot 
bottles  should  be  applied  to  the  feet  and  cold  wet 
cloths  to  the  head. 

When  there  is  much  pain,  heat,  or  swelling  of  the 
throat,  or  when  the  little  patches  of  fibrinous  exuda¬ 
tion  become  visible  on  the  mucous  membrane  of  the 
tonsils,  or  elsewhere,  the  local  treatment  must  be 
varied  accordingly.  Cold  applications  must  be  now  re¬ 
sorted  to,  and  employed  thoroughly  and  perseveringly 
until  the  morbid  secretion  is  arrested.  Sips  of  very 
cold  water  may  be  taken  frequently,  or,  what  is  still 
better,  bits  of  ice  may  be  put  into  the  mouth  and  al¬ 
lowed  to  melt  away,  while  the  throat  is  enveloped  in 
cold  wet  cloths.  The  indication  now  is  to  check  the 
violence  of  the  inflammation,  and  thus  arrest  the  exu¬ 
dation  of  the  membranous  material ;  and  there  is  no 
way  to  do  this  so  certainly  and  so  effectually  as  to  re¬ 
duce  the  morbid  heat  below  the  point  which  is  essen¬ 
tial  to  the  excretion  of  coagulable  lymph.  This  plan 
has  been  employed  in  thousands  of  cases  of  croup 
with  almost  uniform  success.  And  in  the  ulcerated 
sore  throat  of  malignant  scarlet  fever,  it  is  the  only  re¬ 
liable  resource. 

If  the  patient  is  at  any  time  troubled  with  harassing 
cough,  difficult  expectoration,  or  laborious  respiration, 
or  all  together,  after  the  violence  of  the  inflammation 
has  subsided,  warm-water-drinking,  to  the  extent  of 
inducing  vomiting  if  need  be,  should  be  resorted  to. 
And  in  the  later  stage  of  the  disease,  when  the  con¬ 
creted  exudation  is  firmly  adherent  to  the  mucous  sur¬ 
face,  or  has  extended  widely  in  the  bronchial  tubes, 
warm  fomentations  to  the  chest  and  throat  are  proper. 


246 


Diptheria. 


To  these  cases  the  moist  atmosphere,  or  vapor,  as  rec¬ 
ommended  by  Dr.  Sayre,  is  especially  adapted. 

Although  the  fever  may  in  some  cases  be  violent,  so 
far  as  severity  of  symptoms  is  concerned,  and  the 
throat  affection  intense,  so  far  as  the  inflammatory  ac¬ 
tion  is  concerned,  yet  as  the  diathesis  is  always  atonic 
or  asthenic,  these  conditions  will  much  sooner  yield  to 
the  proper  cooling  remedies  named  than  they  will  in 
the  truly  entonic  or  sthenic  diathesis.  In  what  is  prop¬ 
erly  denominated  entonic  visceral  inflammation,  that 
is,  enteric  or  sthenic  fever,  with  active  or  phlegmo¬ 
nous  inflammation,  patients  will  frequently  bear  to 
be  packed  in  double  wet-sheets,  with  advantage ;  and 
these  may  frequently  be  repeated  two  or  three  times 
in  twenty-four  hours.  But  the  preternatural  heat  is 
never  so  persistent  in  diptheria.  The  wet-sheet  pack 
rarely  requires  more  than  one  application  in  twenty- 
four  hours,  and  it  seldom  happens  that  more  than  two 
or  three  repetitions  of  this  process  are  necessary  to 
materially  mitigate  the  violence  of  the  febrile  action ; 
after  which,  should  the  skin  incline  to  feverishness,  the 
tepid  ablution  will  be  sufficient. 

Abundance  of  pure  fresh  air  is  quite  as  important 
in  the  treatment  of  diptheria  as  are  the  bathing  pro¬ 
cesses.  BTo  doubt  the  contagiousness  or  non-conta¬ 
giousness  of  the  disease  depends  very  much  on  the 
means  which  are  employed  to  ventilate  and  cleanse 
the  apartment.  The  patient  should  be  kept  comfort¬ 
able,  by  means  of  bed-clothes,  and  fire  if  necessary,  but 
on  no  consideration  should  all  of  the  windows  and 
doors  be  closed  for  a  moment.  The  safety  of  others  as 
well  as  of  the  patient  may  depend  on  this  precaution. 
In  close  rooms,  and  in  underground  apartments,  where 
free  ventilation  by  doors  and  windows  is  impossible. 


Hygienic  Treatment. 


247 


the  air  of  the  place  may  be  purified  to  a  great  extent 
by  swinging  the  door  vigorously  forward  and  back¬ 
ward.  In  this  way,  in  the  crowded  tenement  houses 
of  our  cities  and  large  villages,  fresh  air  may  be  sup¬ 
plied  and  the  accumulated  miasms  expelled,  when 
there  is  no  other  possible  method  for  “  raising  the 
breeze.” 

The  purifying  and  invigorating  influence  of  light  and 
sunshine  should  never  be  disregarded.  They  are  use¬ 
ful  in  nearly  all  morbid  conditions,  and  of  especial 
value  in  the  management  of  putrid  and  infectious 
febrile  and  inflammatory  diseases.  When  practicable, 
the  rays  of  the  sun  should  be  admitted  freely  into  the 
sick  chamber,  and,  during  the  day,  the  room  should 
be  as  well  lighted  as  possible.  But  at  night,  when  the 
external  senses  of  the  patient  need  quiet  and  repose, 
light  should  be  excluded  ;  nor  should  the  talking  or 
whispering  of  watchers  be  allowed  in  the  room. 

Rest  is  an  important  element  in  the  Hygienic  treat¬ 
ment  of  disease.  And  there  is  no  remedial  resource  so 
little  understood  and  so  generally  disregarded  as  this. 
A  majority  of  physicians  seem  to  have  no  idea  of  its 
necessity  or  value  ;  or  if  they  do,  they  ignore  it  alto¬ 
gether  in  practice.  Indeed,  rest  is  out  of  the  question 
if  the  patient  must  be  disturbed  and  disquieted  with 
some  dose,  or  drug,  or  slop,  every  hour  or  every  half 
hour,  and  even  awakened  out  of  sleep,  if  he  is  so  for¬ 
tunate  as  to  be  able  to  slumber,  to  swallow  something 
which  does  more  harm  than  good. 

The  chief  point  of  skill  in  the  true  physician  is  to 
know  when  to  let  the  patient  alone.  It  is  easy  to  perceive 
morbid  phenomena,  and  to  combat  symptoms  ;  but  to 
know  when  Nature  is  doing  just  right,  and  when  she 
should  not  be  interfered  with,  require  judgment  and 


248 


Diptheria. 


discrimination.  “  Let-alone-ativeness”  'is  tlie  chief 
merit  of  Homeopathy.  The  patient  is  amused  with 
infinitesimal  placebos,  while  Nature  has  time  and 
opportunity  to  remove  the  causes  of  disease,  and  then 
the  cure  results  as  the  necessary  consequence  of  having 
nothing  more  for  the  vis  medicatrix  to  do. 

So  far  as  food  and  diet  are  concerned,  very  little 
need  be  said.  As  I  have  already  intimated,  the  prac¬ 
tice  of  stuffing  the  patient  continually  on  what  the 
doctors,  with  consistent  absurdity,  call  “  nourishing 
diet,55  is  exceedingly  pernicious.  During  the  acute 
stage  of  the  disease,  while  the  fever  is  violent  and  the 
inflammation  severe,  no  food  can  be  digested,  and 
none  should  be  taken.  As  the  fever  subsides,  the 
patient  may  be  allowed  a  little  gruel,  and  good  fruit, 
to  be  followed,  as  convalescence  advances,  with  such 
farinaceous  articles  as  mealy  potatoes,  beans,  peas, 
unleavened  bread,  etc.  Baked  apples,  tomatoes, 
stewed  or  raw,  sweet  oranges,  etc.,  may  generally  be 
allowed  as  freely  as  the  patient  desires,  and,  until  the 
crisis  of  the  disease  is  fairly  passed,  no  other  food  is 
required. 

Drink  may  be  taken  according  to  thirst ;  but  when 
there  is  great  thirst  with  a  disposition  to  vomit,  very 
small  draughts  should  be  taken  and  frequently  re¬ 
peated.  There  is  no  objection  in  such  cases  to  the 
juices  of  acid  and  subacid  fruits,  properly  diluted,  as 
lemon  juice,  apple  water,  oranges,  etc.  Dried  berries, 
stewed  and  slightly  sweetened,  will  answer,  in  some 
cases,  for  both  victuals  and  drink.  In  New  York 
city,  and  probably  in  most  other  parts  of  the  country, 
dried  blackberries,  raspberries,  and  whortleberries  can 
be  had  in  abundance  in  the  winter  season.  Preserved 
berries  can  also  be  found,  nearly  as  fresh  and  savory 


Hygienic  Treatment. 


249 


as  when  first  picked  from  the  hushes.  The  value  of  a 
really  frugivorous  diet,  in  febrile  diseases,  has  never 
been  sufficiently  appreciated. 

Enemas  may  be  necessary  in  the  early  stage  of  the 
disease,  but  are  seldom  required  afterward.  In  the 
outset  of  the  disease,  provided  there  has  been  no 
diarrhea,  the  bowels  should  be  moved  freely  with  an 
injection  of  tepid  water  ;  and  subsequently  only  when 
a  sense  of  fullness  and  distention  of  the  abdomen  indi¬ 
cates  the  presence  of  accumulated  fecal  matters. 

When  vomiting  becomes  a  troublesome  symptom  or 
complication,  small  bits  of  ice  may  be  occasionally 
swallowed,  or  frequent  sips  of  cold  water  taken,  and  a 
cold  wet  towel  covered  with  a  dry  cloth  should  be 
applied  over  the  region  of  the  stomach. 

Diarrhea  can  be  relieved  by  means  of  warm  fomenta¬ 
tions  to  the  abdomen,  and  small  enemas  of  cool  or  cold 
water,  administered  immediately  after  the  evacuations. 
The  patient  should  keep  the  horizontal  posture,  and  be 
as  quiet  as  possible. 

Albuminaria  does  not  require  any  special  medica¬ 
tion. 

Hemorrhages  can  generally  be  promptly  checked 
with  cold  applications. 

Extreme  swelling  of  the  glands  of  the  neck  requires 
the  constant  application  of  wet  cloths  to  the  part. 

Coma  may  be  relieved  by  cold  applications  to  the 
head  and  warm  ones  to  the  feet.  In  extreme  cases, 
fomentations  to  the  abdomen  may  be  employed  advan¬ 
tageously. 

The  sequelae  of  diptheria  demand  only  a  strict  atten¬ 
tion  to  the  general  health,  except  so  far  as  they  are  the 
effects  of  drug-medicines,  and  then  all  the  appliances 
for  purification  must  be  brought  into  requisition. 

11* 


250 


Diptheria. 


That  the  plan  of  treatment  I  have  now  detailed  is 
successful,  I  have  not  only  my  own  experience,  and 
that  of  other  physicians  of  the  Hygeio-Therapeutic 
School,  to  offer  as  evidence,  but  I  have  also  the  testi¬ 
mony  of  some  of  the  drug  doctors  themselves.  As  an 
illustration,  I  will  give,  in  full,  an  article  published  in 
the  Dansville  (H.  Y.)  Herald  : 

“  DIPTHERIA,  SORE  THROAT,  AND  QIJINSV  SUCCESSFULLY 
TREATED  BY  THE  LOCAL  APPLICATION  OF  ICE. 

“Dansville,  Feb.  18,  1861. 

“  Mr.  Editor — Hear  Sir :  Allow  me,  through  the 
columns  of  your  valuable  journal,  to  make  some  prac¬ 
tical  remarks  on  the  subject  of  diptheria.  I  shall  con¬ 
fine  myself  to  the  consideration  of  its  early  symptoms, 
and  its  early  or  abortive  treatment.  I  do  not  propose 
to  enter  into  a  lengthy  discussion  as  to  what  is  or  what 
is  not  diptheria,  except  so  far  as  to  make  myself  under¬ 
stood  as  to  the  treatment,  that  being  what  I  most  de¬ 
sire  to  bring  to  the  notice  of  your  patrons  and  the 
public  generally.  Hence,  sir,  what  I  have  to  say  will 
be  as  strictly  practical  as  may  be.  If,  by  any  course 
of  treatment,  the  early  or  premonitory  symptoms  can 
be  stopped,  then  we  have  no  diptheria. 

“  How,  sir,  I  have  had  this  disease  to  treat  constantly 
for  the  last  twenty  months,  and  what  I  have  to  say  is 
the  result  of  actual  observation  and  experience  ;  there¬ 
fore  it  is  not  the  result  of  mere  speculation  and  theory, 
of  which  we  have  had  quite  enough.  I  conceive  it  to 
be  about  time  for  somebody  to  bring  the  subject  down 
to  facts,  and  these  facts  sustained  by  a  uniform  success 
in  practice,  applied  according  to  the  rules  which  ex¬ 
perience  has  found  necessary  to  be  observed. 

“  Then,  sir,  we  lay  it  down  as  an  axiom,  that  dip¬ 
theria  in  its  early  stages  is  nothiug  more  nor  less  than 


Hygienic  Treatment. 


251 


an  inflammation,  and  that  there  never  was  a  case  of 
diptheria  without  a  preceding  inflammation  to  a 
greater  or  less  extent,  and  that  the  inflammation  has  a 
termination  peculiar  to  itself. 

“  Again  we  lay  it  down  as  an  axiom,  that  no  man, 
however  close  his  observation,  can  distinguish  between 
an  inflammation,  the  termination  of  which  will  be 
diptheria,  and  one  the  termination  of  which  will  be 
pus,  as  in  common  tonsillitis,  quinsy,  or  gangrene  and 
sloughing,  as  in  putrid  sore  throat.  While  the  inflam¬ 
mation  is  being  developed  previous  to  its  termination, 
the  result  can  not  be  foretold  with  any  degree  of  cer¬ 
tainty.  That  inflammation  of  the  throat  results  in  one 
of  the  three  mentioned  forms,  daily  experience  veri¬ 
fies  ;  that  is  to  say,  in  an  exudation  which  immediately 
becomes  organized  tissue,  forming  the  false  membrane, 
which  constitutes  a  case  of  diptheria.  This  membrane 
may  be  in  small  and  separate  patches,  or  it  may  ex¬ 
tend  all  over  the  back  part  of  the  mouth  and  upper 
part  of  the  windpipe,  and  even,  as  it  sometimes  does, 
travel  down  into  the  smaller  bronchial  tubes.  It  is 
the  formation  of  this  false  membrane  which  constitutes 
a  case  of  diptheria. 

“  Then  as  to  the  other  two  terminations  of  inflam¬ 
mation  of  the  throat  (and  one  that  is  scarcely  less  fatal), 
we  may  say  that  one  is  that  of  mortification  or  slough¬ 
ing,  called  putrid  sore  throat,  the  other  is  in  the  forma¬ 
tion  of  matter  or  pus ;  this  is  designated  quinsy  or 
tonsillitis. 

“  Having  thus  briefly  stated  what  experience  bears 
me  out  in  saying  in  relation  to  the  early  stages  of  this 
truly  frightful  disease,  before  stating  the  treatment 
proper,  I  wish  to-  say  a  word  in  relation  to  what  I 
think  an  erroneous  and  unsafe  theory — that  is,  that  the 


252 


Diptheria. 


disease  is  constitutional,  and  that  the  soreness  of  the 
throat  is  but  the  local  manifestation  of  a  general  or 
constitutional  diseased  action.  Now,  sir,  I  hold  the 
reverse  to  he  the  truth  ;  that  is,  that  the  disease  of  the 
throat  is  the  disease ,  and  that  the  constitution  becomes 
affected  by  absorption  of  the  poison  from  the  throat, 
the  same  as  in  the  case  of  vaccination,  when  the  mere 
speck  of  matter  inserted  under  the  skin  of  the  arm  pro¬ 
duces  a  general  affection,  viz.,  kine-pox.  I  hold  this 
theory  of  the  primary  taint  of  symptoms  to  be  unsafe, 
from  the  fact  that  it  misleads  the  physician,  and  his 
poor  patient  has  been  caused  to  swallow  large  doses 
of  drastic  purges  and  the  like,  in  order,  as  he  says,  to 
rid  the  poor  victim  of  some  imaginary  poison.  But 
above  all  it  has  caused  him  to  neglect  the  proper  treat¬ 
ment  of  the  throat  trouble,  and  thereby  allowing  the 
only  chance  to  slip  ;  and  this  very  poison  which  is 
so  much  dreaded,  time  to  absorb  into  the  system  at 
large,  and  this  to  bring  on  a  fatal  typhoid  train  of 
symptoms. 

“  Then  to  recapitulate.  Diptheria,  in  its  early 
stages,  is  but  an  inflammation,  having  a  termination 
peculiar  to  itself,  yet  subject  to  the  same  laws  that 
govern  other  inflammations,  viz.,  heat,  redness,  and 
swelling,  producing  soreness  just  in  proportion  to  the 
amount  of  inflammation,  and  the  fever  which  attends 
is  in  exact  ratio  to  the  amount  of  local  or  throat 
trouble.  Believing  that  I  have  made  myself  capable 
of  being  understood,  I  will  now  proceed  with  the 
treatment. 

“  First,  then,  envelop  the  neck  in  cloths  wrung  out 
of  cold  water  (it  is  not  the  water  but  the  cold),  chang¬ 
ing  them  as  often  as  they  get  warm.  If  there  is  much 
swelling  near  the  angle  of  the  jaw,  apply  a  bladder 


Hygienic  Treatment. 


253 


with  a  handful  of  snow ,  so  arranged  as  to  form  a  small 
surface.  This  should  be  placed  directly  over  the  ton¬ 
sils.  So  much  for  the  external  applications. 

“  If  there  is  not  much  swelling  externally,  the  cold 
cloths  or  snow  may  be  omitted,  and  the  case  may  be 
trusted  to  internal  applications.  The  patient  should  go 
to  bed,  and  laying  upon  the  back  should  take  a  small 
piece  of  ice  into  the  mouth  and  allow  it  to  settle  as  far 
down  as  possible  without  swallowing  it.  When  this  has 
melted,  he  should  spit  out  the  water  and  have  a  fresh 
piece  of  ice  applied.  This  will  require  a  faithful  and 
attentive  nurse.  The  pieces  of  ice  should  be  about  as 
large  as  the  first  joint  of  the  finger.  By  pursuing  this 
course  in  the  early  stages  of  the  disease,  it  will  be 
cured  in  from  twelve  to  twenty-four  hours.  If  the  dis¬ 
ease  has  got  a  little  further  advanced,  yet  in  its  inflam¬ 
matory  stages,  with  high  febrile  action,  put  the  patient 
into  a  warm  bath,  keep  him  there  until  he  feels  faint ; 
take  him  out,  wrap  him  in  warm  flannel  blankets  and 
sweat  him  for  one  or  two  hours,  after  which  maintain 
a  gentle  perspiration  for  three  or  four  days  ;  for  be  it 
known  that  absolute  rest  for  this  length  of  time  is 
essential.  The  ice  is  to  be  continued  at  the  same  time. 

“  This  may  seem  to  be  a  very  simple  treatment  for 
so  formidable  a  malady  ;  but  that  is  a  mistake,  for  we 
have  not  a  more  powerful  remedial  agent  than  ice  when 
properly  applied  ;  besides  being  formidable  it  is  capa¬ 
ble  of  perfect  management,  and  all  that  is  necessary  is 
to  graduate  the  amount  of  cold  to  the  degree  of  inflam¬ 
mation.  It  also  has  another  valuable  feature,  that  of 
always  being  on  hand,  especially  at  this  time  of  year. 

“  I  am  confident,  from  a  long  experience  in  the  use 
of  this  remedy,  that  if  people  will  observe  and  apply  as 
above  directed,  that  diptheria  will  be  shorn  of  its  terror 


254: 


Dipthekia. 


and  many  a  valuable  life  saved.  Remember  that  it 
must  be  used  early,  from  the  first  accession  of  throat 
symptoms,  and  persevered  in  until  they  are  removed. 

“  This  treatment  may  and  probably  will  meet  with 
the  same  reception  that  all  great  principles  have  when 
first  brought  before  the  world  of  mind — that  is,  that  it 
is  an  innovation,  and  some  of  the  wise  old  ones  will 
shake  their  heads  doubtingly.  But  I  hold  that  dis¬ 
ease  when  it  can  be  cured  should  be,  whether  it  be  ac¬ 
cording  to  authority  or  without  authority.  Sir,  where 
would  be  the  mighty  improvements  that  have  been 
made  in  medicine,  if  nobody  should  take  a  step  beyond 
authority  ?  Respectfully  yours, 

“  Z.  H.  Blake,  M.D.” 

I  am  decidedly  opposed  to  sweating  any  diptheritic 
patient  for  one  or  two  hours.  Many  patients  will  bear 
it,  and  all  may  if  the  sweating  be  not  too  profuse ;  nor 
would  I  make  it  a  point  to  keep  the  patient  in  the  warm 
bath  until  he  feels  faint.  A  warm  bath  of  ten  or  fif¬ 
teen  minutes’  duration  is  sufficient,  and  if  all  faintness 
is  avoided  so  much  the  better.  It  is  well,  afterward, 
to  keep  the  patient  quiet,  and  the  skin  in  a  moist,  per¬ 
spirable  state  ;  but  anything  like  profuse  sweating  is 
to  be  deprecated. 

Dr.  Blake  makes  no  allusion  to  “Water-Cure,”  or 
“  Hydropathy,”  nor  does  he  give  the  least  hint  that  he 
ever  knew  or  heard  of  a  case  of  diptheria  being  treated 
with  cold  water  and  colder  ice,  with  external  warm  or 
cold  bathing,  and  without  drugs  of  any  kind,  except 
in  his  own  practice.  So  far  as  one  can  infer  from  his 
article,  this  practice  with  him  is  entirely  original. 
The  statement,  “  I  have  had  this  disease  to  treat  con¬ 
stantly  for  twenty  months,  and  what  I  have  to  say  is 
the  result  of  actual  observation  and  experience,”  may 


Hygienic  Treatment. 


255 


be  interpreted  in  various  ways.  His  observations  may 
have  been  made  on  the  cases  which  were  treated  by 
other  physicians,  and  who  have  treated  it  in  the  way 
he  recommends. 

At  all  events,  it  is  true  that  many  cases  of  diptheria 
were  treated  in  Dansville,  and  several  of  them  at 
the  water-cure  of  Hr.  Jackson,  in  that  place,  and  all 
successfully,  previous  to  the  date  of  Hr.  Blake’s  arti¬ 
cle.  And  it  is  also  true  that  the  Water-Cure  Journal , 
which  circulates  largely  in  Hansville,  had  previously 
and  repeatedly  advocated  a  similar  plan  of  treatment. 

The  theory  advanced  by  Hr.  Blake,  that  the  causes 
of  the  disease  are  essentially  local,  and  that  the  consti¬ 
tutional  disturbance  results  from  the  absorption  of  the 
local  infection,  has  been  sufficiently  refuted  in  the  pre¬ 
ceding  part  of  this  work.  But  as  Hr.  Blake  predicates 
on  the  theory  which  he  adopts  a  very  plausible  argu¬ 
ment  against  the  employment  of  drug-remedies^  it  seems 
needless  to  correct  the  error,  so  far  as  diptheria  is  con¬ 
cerned.  But  the  principle  involved  applies  to  other 
diseases — indeed,  to  all  diseases. 

Hr.  Blake  objects  to  the  internal  use  of  poisonous 
drug's,  because  the  causes  of  the  disease  are  not  in 
the  blood,  but  on  the  mucous  membrane  of  the  throat. 
Will  not  this  reasoning  apply  to  other  diseases  as  well 
as  diptheria  ?  Again,  if  drug-medication  is  proper  per 
se ,  and  if  diptheria  is  primarily  a  mere  throat  affection, 
why  not  apply  drugs  to  the  throat  ?  If  drugs  are 
really  and  properly  curative  agents,  here  is  one  of  the 
best  imaginable  opportunities  for  employing  them  ju¬ 
diciously  and  successfully,  because  we  can  see  the  dis¬ 
eased  part,  and  have  the  evidence  of  our  senses  as  to  - 
the  modus  operandi  and  effects  of  the  medicines. 
Here  is  inflammation,  for  which  bleeding,  niter,  anti* 


256 


Diptheuia. 


mony,  digitalis,  salts,  yeratria,  arnica,  aconite,  gelsemi- 
num,  and  all  the  host  of  antiphlogistics  and  narcotics 
have  such  a  reputation  for  curing  ;  and  here  is  (accord¬ 
ing  to  Dr.  Blake)  a  locally  generated  virus,  and  what 
mortal  doctor  of  the  drug  school  ever  conceived  the 
possibility  of  arresting,  correcting,  suppressing,  de¬ 
stroying,  or  killing,  or  curing  a  virus  without  a  specific 
drug,  or  a  counter-poison,  or  an  “  alterative,”  without 
mercury  in  some  form  ? 

But,  no.  Dr.  Blake  proposes  simply  to  cool  the 
virus,  to  refrigerate  the  inflammation.  He  relies  on 
temperature  alone  to  destroy  the  infection,  arrest  the 
inflammation,  prevent  or  remove  the  fever,  and  restore 
the  patient  to  health.  He  is  right  in  practice,  but 
wrong  in  theory.  Should  he  adopt  the  true  theory  and 
give  the  correct  explanation,  he  could  not  long  main¬ 
tain  before  the  world  the  position  of  drug  doctor. 

Dr.  Blake  reasons  that,  because  the  disease,  or  its 
cause,  is  local,  it  can  be  cured  without  drugs.  But, 
admitting  the  disease,  or  its  cause,  to  exist  in  the  blood, 
why  can  not  it  also  then  be  removed  or  cured  wflthout 
drugs  %  Dr.  Blake’s  practice  is  revolutionary ;  and  I 
am  unwilling  that  an  ingenious  sophistication  shall  be 
allowed  to  save  the  theory  of  drug-medication  from  its 
damaging  influence. 

In  all  the  places  which  I  have  visited  during  the  last 
year,  I  have  made  special  inquiries  as  to  the  prevalence 
of  diptheria,  the  manner  in  which  it  has  been  treated 
by  the  physicians,  and  the 'rate  of  mortality.  And  all 
the  information  I  have  been  able  to  collect  from  others, 
agrees  precisely  with  my  own  observations  and  expe¬ 
rience.  Wherever  the  Hygienic  plan  of  treatment, 
substantially  as  recommended  in  this  work,  has  been 
adopted  at  the  commencement  of  the  disease,  and  per- 


Hygienic  Treatment. 


257 


severed  in  to  the  end,  to  the  total  exclusion  of  all  drug- 
medication,  local  or  constitutional,  no  death  has  yet 
come  to  my  knowledge.  In  three  or  four  instances, 
where  the  patients  were  badly  scrofulous,  or  very  gross 
in  dietetic  habits,  and  where  the  physician  was  not 
called  until  the  membranous  exudation  had  extended 
to  the  bronchial  tubes,  the  cases  have  terminated  fatally. 
But  such  can  hardly  be  regarded  as  exceptions  to  the 
uniform  success  of  Hygienic  treatment. 

I  do  not  claim,  nor  do  I  believe,  that  all  cases  are 
curable  by  the  means  which  I  recommend.  Ho  doubt 
there  are  cases  which  are  incurable  by  any  means 
whatever.  There  are,  undoubtedly,  persons  so  gross 
in  body,  so  depraved  in  blood,  so  frail  in  organization, 
or  so  feeble  in  vital  resources,  that  the  existence  of 
diptheria  necessitates  death.  But  these  cases  are  ex¬ 
ceptions,  and  rare  ones  too,  to  the  general  rule. 

I  have  heard  from  more  than  one  dozen  of  the  grad¬ 
uates  of  the  Hew  York  Hygeio-Therapeutic  College, 
who  have  treated  each  rom  one  to  twenty  cases  of 
diptheria  and  putrid  sore  throat,  without  as  yet  losing  a 
single  patient. 

While  riding  on  the  cars  from  Iowa  City  to  Chicago, 
in  the  month  of  January  last,  I  made  the  acquaintance 
of  Mr.  C.  Manfull,  of  Augusta,  Ohio,  who  was  return¬ 
ing  from  a  trip  to  the  West.  Mr.  Manfull  informed 
me  that,  seven  or  eight  years  ago,  he  purchased  the 
“  Hydropathic  Encyclopedia,”  and  subscribed  for  the 
Water-Cure  Journal ,  since  which  time  he  has  treated 
his  own  and  many  of  his  neighbors’  children,  when 
sick  of  croup,  diptheria,  or  any  form  of  sore  throat, 
with  invariable  success,  having  never  lost  a  patient. 
He  informed  me  also  that  an  eminent  allopathic  physi¬ 
cian  in  Steubenville,  Ohio,  where  the  diptheria  had  been 


258 


Diptheria. 


extensively  prevalent  and  very  fatal,  had  possessed 
himself  of  the  “ Encyclopedia,55  adopted  the  Hygienic 
treatment,  and  abandoned  all  drug-medication,  after 
which  very  few  deaths  occurred  in  the  place.  He 
stated,  moreover,  that  Dr.  Beaumont,  of  Cumberland, 
Va.,  had  treated  many  cases  of  croup,  diptheria,  and 
malignant  scarlet  fever  hygienically,  and  had  not  lost 
one  patient.  Dr.  Beaumont  has  delivered  public  lec¬ 
tures  on  “Hygienic  versus  Drug-Medication,35  with 
good  effect. 


TRACHEOTOMY. 

As  a  last  resort,  when  the  false  membrane  is  so 
obstructing  the  air-passages  as  to  endanger  imme¬ 
diate  suffocation,  this  operation  is  recommended  by 
some  authors.  It  is  at  least  highly  probable  that  some 
lives  have  been  saved  by  the  operation,  but  there  is 
reason,  too,  to  believe  that,  in  some  cases,  life  has  been 
destroyed  by  it.  It  is  not  always  possible  to  determine, 
whether  the  patient  survives  the  operation  or  not,  what 
influence  the  measure  had  in  determining  the  result. 

During  the  year  1856  there  were  fifty-four  opera¬ 
tions  of  tracheotomy  for  croup,  at  the  Children’s  Hos¬ 
pital  in  Paris.  Of  these  cases  fifteen  recovered.  M. 
Guersant  testifies  that,  in  the  cases  in  which  he  has 
operated,  about  one  third  have  recovered.  M.  Bou- 
chat  operated  on  one  hundred  and  sixty,  and  only  five 
were  saved.  M.  Bretonneau  performed  the  operation 
in  twenty  cases,  of  which  six  recovered.  M.  Yelpeau 
operated  ten  times,  and  two  of  his  patients  recovered. 
AT.  Perit  operated  in  six  cases,  and  in  three  of  the 
cases  the  patients  were  saved. 

The  results  of  three  hundred  and  eighty  operations, 


Tracheotomy. 


259 


reported  by  M.  Chaillon,  were,  two  hundred  and 
ninety-four  deaths,  and  eighty-six  recoveries. 

The  statistics  of  the  Hospital  des  Enfants  show  a 
mortality  of  five  to  one. 

In  Great  Britain,  so  far  as  the  statistics  have  been 
reported,  the  results  of  the  operation  have  been  some¬ 
what  less  favorable  than  in  France. 

The  statistics  of  American  authors  are  exceedingly 
meager  on  this  subject,  but  do  not  vary  materially  from 
the  reports  of  the  French  and  British  hospitals. 

Dr.  Gross,  of  Louisville,  Kentucky,  has  published 
the  particulars  of  one  hundred  and  seventy-six  cases 
of  foreign  bodies  in  the  larynx ;  in  sixty-eight  of  these 
cases  the  operation  of  tracheotomy  was  performed, 
with  a  mortality  of  tmly  eleven  per  cent.  But  the 
success  or  propriety  of  the  operation,  in  these  cases, 
must  be  predicated  on  very  different  premises  from 
those  which  apply  to  the  necessity  or  utility  of  the 
operation  in  diptheria. 

It  is  true  that  the  operation  of  tracheotomy  is  not  in 
itself  a  very  difficult  nor  dangerous  operation  in  adults, 
yet  with  young  children  the  case  is  very  different,  and 
requires  the  utmost  surgical  skill  and  dexterity.  And 
when  the  patient  is  extremely  exhausted,  the  pain  and 
alarm  necessarily  attending  the  operation  might  be 
sufficient  to  turn  the  scale  against  the  patient. 

Many  authors  have  objected  to  the  operation  on  the 
ground  that  it  is  apt  to  induce  severe  bronchitis,  or 
greatly  to  aggravate  the  previously  existing  inflam¬ 
mation. 

The  only  condition  in  which  the  operation  can  be 
called  for  or  justified  is  when  the  diptheritic  exudation 
has  extended  to  the  larnyx,  and  has  become  so  firmly 
concreted  and  adherent  to  the  membrane  as  to  threaten 


260 


Dipthekia. 


death  by  suffocation.  In  these  cases  it  is  obviously 
possible  to  keep  np  the  respiration  by  means  of  an  ar¬ 
tificial  opening  into  the  windpipe,  until  the  false  mem¬ 
brane  can  be  cast  off’  and  expelled.  It  is,  of  course, 
a  desperate  expedient,  and  so  much  so  that  many  prac¬ 
titioners  of  eminence  and  experience  proscribe  it  en¬ 
tirely.  There  can  be  no  doubt  that  the  operation  has, 
in  many  cases,  probably  in  a  great  majority,  been  re¬ 
sorted  to  when  the  patient  was  actually  moribund,  so 
that  the  deaths  were  scarcely  at  all  influenced  by  it. 

The  proper  time  for  performing  the  oj^eration,  pro¬ 
vided  it  be  proper  in  any  case,  is  not  very  precisely 
determined  by  the  authors  who  have  written  on  the 
subject.  “We  should  not  wait  until  the  case  is  des¬ 
perate,  or  the  patient  in  a  dying  condition,55  says  one ; 
nor,  says  another,  a  should  we  attempt  the  operation 
too  early,  before  other  remedies  had  been  fairly  and 
completely  tested.55 

But  as  to  what  precise  time  may  be  regarded  as  the 
proper  “  middle  period,55  and  how  wre  are  to  know 
when  all  other  remedies  have  been  “  fairly  and  com¬ 
pletely  tested,55  we  are  left  entirely  in  the  dark.  Dr. 
Slade  quotes  approvingly  the  following  rule  as  to  time : 
“  so  soon  as  ever  we  feel  .that  our  remedies  are  too 
tardy  to  overtake  the  disease.55 

This  may  be  an  excellent  rule  for  the  conscience,  but 
a  very  poor  one  for  the  judgment.  A  physician  may 
practice  very  conscientiously,  yet  very  injudiciously. 
The  important  information  which  the  authors  do  not 
give  us  is,  by  what  symptoms  are  we  to  know  wdien  to 
perform  tracheotomy  ? 

There  is,  I  apprehend,  no  better  rule  to  be  governed 
by  in  determining  this  question  than  the  one  I  have 
already  intimated.  When  the  patient  is  in  a  state  of 


STIMULATION  YS.  AnTIPIILOGISTICATION.  261 

actual  suffocation  from  the  presence  of  the  false  mem¬ 
brane  in  the  larynx,  and  the  strength  not  greatly  ex¬ 
hausted,  the  operation  wi_l  be  justifiable  ;  but  whether 
it  will  even  then  increase  or  decrease  the  chance  of  re¬ 
covery,  is  a  problem  which  I  regard  as  by  no  means  to 
be  settled  by  the  data  before  us. 

The  operation  consists  in  making  an  opening  into 
the  windpipe,  a  short  distance  below  the  larynx,  and 
introducing  a  canula,  through  which  respiration  can 
go  on.  It  is  important  that  the  canula  be  large  enough, 
or  suffocation  would  soon  take  place ;  and  great  care 
must  be  taken  to  keep  the  instrument  free,  or  respira¬ 
tion  may  cease  from  a  stoppage  of  the  tube.  The  gen¬ 
eral  custom  is  to  allow  the  tube  to  remain  four  or  five 
days,  and  renew  it  should  difficult  breathing  recur  on 
its  removal. 

Tubing  of  the  glottis ,  an  experiment  introduced  by 
M.  Bouchat,  has  been  resorted  to  by  other  practition¬ 
ers.  The  process  consists  in  inserting  into  the  larynx, 
through  the  mouth,  a  metallic  tube,  through  which 
respiration  is  to  be  maintained.  The  most  that  is  pre¬ 
tended  in  favor  of  this  operation  is,  that  it  may  delay 
asphyxia,  and  perhaps  post23one  for  awhile  the  neces¬ 
sity  for  tracheotomy. 

STIMULATION  YS.  ANTIPIILOGISTICATION. 

I  have  now  placed  before  the  reader  all  the  import¬ 
ant  facts  and  theories  I  can  find  in  medical  books  and 
journals  concerning  the  nature  and  treatment  of  dip- 
theria,  with  the  opiuions  of  medical  writers  and  teach¬ 
ers  for  or  against  the  various  methods  of  medication 
which  have  been  proposed ;  and  an  explanation  of  the 
Hygienic  plan  of  treatment,  with  the  reasons  therefor. 


262 


Diptheria. 


But  I  can  not  conclude  this  work  satisfactorily  to  myself 
without  a  chapter  devoted  especially  to  the  refutation 
of  the  gross  error  of  the  medical  profession,  and  the 
great  delusion  of  the  people,  not  only  as  respects  the 
nature  and  treatment  of  diptheria,  but  with  regard  to 
the  proper  management  of  all  diseases. 

Medical  men  always  act  from  some  recognition  of  a 
theory,  however  vague  and  indefinite  it  may  be.  What¬ 
ever  doctrine  or  hypothesis  the  physician  entertains 
respecting  the  intrinsic  nature  of  any  malady,  it  will  in 
some  manner  influence  his  prescriptions  at  the  bedside 
of  the  patient. 

It  is  true  that  a  large  class  of  practitioners,  finding 
by  experience  that  all  the  doctrines  of  medical  books 
and  schools  are  unsatisfactory,  that  all  of  the  practice 
recommended  by  the  standard  authorities  is  uncertain, 
and  learning,  too,  by  repeated  disappointments,  that 
the  principles  which  medical  authors  teach  will  seldom 
apply  in  practice,  have  ignored  all  theory,  and  profess 
to  be  guided  only  by  facts.  Their  only  guides  in  the 
treatment  of  disease  are  their  own  observations  and  the 
experience  of  their  predecessors.  But  as  it  happens 
that  the  observations  of  medical  men  are  widely  dif¬ 
ferent,  and  the  experience  of  their  predecessors  (being 
interpreted  so  as  to  agree  with  whatever  theories  they 
happen  to  entertain)  is  as  contradictory  as  is  possible 
to  be,  these  guides  seem  to  be  extremely  fallacious. 

Medical  authors  have  been  contending  for  several 
centuries  whether  the  stimulating  plan  of  treatment, 
or  just  the  opposite,  the  antiphlogistic,  is  the  proper 
one  for  the  treatment  of  certain  febrile  and  inflamma¬ 
tory  diseases,  and  thus  are  quite  as  far  from  any  com¬ 
mon  agreement  now  as  they  were  three  hundred  years 
ago.  Is  it  not  strange  that  not  one  of  them  has  ever 


Stimulation  ys.  Antiphlogistic ation.  263 

thought  of  the  primary  question  which  underlies  this 
discussion — is  either  method  right  f 

It  is  taken  for  granted  that  if  a  disease,  or  the  pa¬ 
tient,  will  not  bear  depletion ,  he  must  have  repletion. 
If  he  can  not  endure  antiphlogi sties,  he  must  be  dosed 
with  stimulants.  If  he  sinks  under  reducing  treat¬ 
ment,  he  must  be  u  supported”  with  fiery  irritants. 
If  he  will  not  tolerate  bleeding,  he  must  be  fed  with 
brandy  ;  and  if  he  can  not  digest  wholesome  food,  he 
must  be  stuffed  and  gorged  on  such  medico- dietetic 
abominations  as  alcoholized  animal  broths,  grog-and- 
chicken  tea,  “  strong  nourishment”  of  wine-and-soup, 
etc.,  etc. 

And,  on  the  other  hand,  if  stimulation  seems  to 
damage  the  patient,  the  antiphlogistic  plan  must  of 
necessity  do  good.  If  the  patient  can  not  bear  “  sup¬ 
porting”  treatment,  he  must  have  the  opposite — the 
reducing.  If  brandy  disagrees,  bleeding  must  be  in 
order,  etc. 

The  whole  error  lies  in  assuming  what  is  not  true. 
Both  practices  are  wrong.  The  indication  of  treat¬ 
ment  is  to  purify ,  not  to  stimulate  nor  antiphlogisti- 
cate.  The  majority  of  physicians  of  the  drug  school 
recommend  bleeding  and  reducing  measures  in  u  in¬ 
flammatory  states”  of  the  system,  and  alcoholic  and 
other  stimulants  in  “  typhous  conditions.”  But  what 
are  inflammatory  states,  and  what  are  typhous  condi¬ 
tions  ?  Here  all  is  confusion  again.  As  we  have  seen, 
some  authors  regard  the  fever  of  diptheria  as  inflam¬ 
matory  or  sthenic,  while  others  regard  it  as  atonic  or 
typhoid.  And  the  same  disagreement  exists  as  to  the 
diathesis  of  the  throat  affection. 

The  idea  that  stimulants  “  support  the  system,” 
“  impart  energy,”  or  temporarily  “  augment  vitality,” 


264 


Diptheria. 


is  the  cause  of  nearly  all  the  malpractice  among  med¬ 
ical  men,  and  of  all  the  dissipation  and  debauchery  in 
the  world.  Stimulants  exhaust  vitality,  as  do  anti- 
phlogistics.  Brandy  and  bleeding,  opium  and  niter, 
quinine  and  antimony,  rum  and  digitalis,  capsicum 
and  veratria,  alike  occasion  the  expenditure  and  waste 
of  vital  power,  as  do  all  poisons  of  whatever  name  or 
nature ;  and  the  notion  that  a  poison  which  is  intrin¬ 
sically  inimical  to  anything  that  has  organic  life,  can 
support  vitality  in  any  degree  or  in  any  sense,  is  one 
of  the  wildest  vagaries  that  ever  possessed  the  minds 
of  human  beings. 

The  grand  mistake  of  medical  men  on  this  subject 
arises  from  a  false  theory  of  the  modus  operandi  of 
medicines.  It  is  everywhere  taught  in  medical  books 
and  schools,  that  medicines  act  on  the  different  parts 
and  organs  of  the  body  in  virtue  of  their  u  inherent 
affinities”  for  those  organs.  Nothing  can  be  more 
absurd.  The  truth  is  exactly  the  contrary.  The 
living  system  acts  on  the  medicines.  It  acts  on  poisons 
to  expel,  them  from  the  vital  domain.  Some  it  expels 
through  the  skin  by  a  prompt  vigorous  determination 
of  blood  and  nervous  energy  to  the  cutaneous  emunc- 
tory  ;  this  process  is -attended  with  a  feverish  state  of 
the  system  and  increased  heat  of  the  surface  ;  this 
abnormal  excitement  or  fever  is  called  “  stimulation 
and  the  article  or  agent  which  occasions  it  is  said  to 
be  a  “  stimulant.” 

The  effect  of  the  medicine,  or  the  poison,  is  a  fever 
or  an  inflammation,  and  nothing  else.  And  a  fever 
or  an  inflammation  can  not  “  impart  vitality”  to  the 
system.  Nothing  can  impart  what  it  does  not  possess. 
It  can  not  “  support”  the  machinery  of  life.  It  is  the 
same  precisely  whether  the  fever  or  the  inflammation — • 


Stimulation  ys.  Antipiilogistication.  265 

the  disease — be  occasioned  by  medicine,  poison,  indi¬ 
gestible  food,  “  catching  cold,”  a  wound,  an  injury  of 
any  kind,  or  any  other  cause.  If  it  exists  at  all,  it  is 
abnormal  action  ;  and  abnormal  action  always  expends 
and  never  augments  vital  power. 

Antiphlogistics  also  occasion  the  waste  and  loss  of 
vital  power,  but  in  a  different  direction,  and  hence  the 
morbid  phenomena  are  very  different.  They  divert 
action  from  the  surface ;  in  other  words,  they  are  re¬ 
sisted  by  a  determination  of  blood  and  nervous  energy 
from  the  circumference  of  the  body  to  the  center,  thus 
occasioning  symptoms  the  very  opposite  of  those  which 
are  called  stimulation.  The  skin  is  cooler,  and  the 
pulse  weaker,  and  the  muscular  power,  instead  of 
being  preternaturally  excited,  is  directly  depressed. 
So  far  as  the  effects  of  stimulants  and  antiphlogistics 
are  concerned,  stimulants  may  be  said  to  be  indirectly 
and  antiphlogistics  directly ,  exhausting. 

A  similar  controversy  has  long  existed  in  the  med¬ 
ical  profession  respecting  the  theory  of  inflammation. 
By  some  authors  inflammation  is  regarded  as  an  in¬ 
creased  action  of  the  blood-vessels  of  the  part,  or,  as 
some  teachers  express  it,  “  inflammation  is  an  aug¬ 
mentation  of  all  the  vital  powers  of  that  part  which  is 
the  seat  of  it while  others  contend  that  it  is  just  the 
contrary,  a  decreased  action  of  the  blood-vessels,  or  a 
diminution  of  all  the  vital  powers  of  that  part  which  is 
the  seat  of  it.  And  this  controversy  is  apparently  no 
nearer  a  settlement  now  than  it  was  a  thousand  years  ago. 

The  subject,  however,  seems  to  be  important;  for 
if  the  theory  of  increased  action  be  true,  the  antiphlo¬ 
gistic  plan  of  treatment  seems  to  be  indicated  ;  while 
if  the  doctrine  of  diminished  action  be  correct,  the 
stimulating  plan  seems  to  be  the  reasonable  one. 

12 


266 


Diphteria. 


But  the  truth  is,  neither  theory  is  correct.  Inflam¬ 
mation  does  not  consist  essentially  in  either  an  in 
creased  or  decreased  strength  of  action  in  the  part 
inflamed  ;  nor  is  there  necessarily  any  augmentation 
or  diminution  of  the  vital  energies  of  the  part.  In¬ 
flammation  is  simply  irregular  or  abnormal  action. 
Whether  the  action  be  strong  or  weak,  so  far  as  the 
circulation  of  the  blood  in  the  part  is  concerned,  is 
quite  immaterial.  It  may  be  one  or  the  other  in  the 
first  instance ;  but  as  the  disease  is  prolonged,  the 
blood-vessels  soon  become  congested  and  over-dis¬ 
tended  ;  the  accumulated  blood  soon  distends  their 
coats  beyond  the  power  of  normal  contraction,  so  that 
debility  soon  becomes  the  permanent  condition. 

But  debility,  or  decreased  action,  is  not  to  be  reme¬ 
died  by  irritating,  exciting,  and  disturbing  the  vital 
energies  with  stimulants.  To  relieve  the  distended 
and  weakened  vessels,  the  destruction  must  be  re¬ 
moved,  and  the  part  allowed  to  rest.  The  blood  should 
be  determined  to  other  parts,  not  taken  out  of  the  body. 

.  H or  is  increased  action  to  be  “  cured”  by  antiphlo- 
gistics.  It  may  be  “  reduced”  or  subdued ,  and  so  may 
all  vital  action  ;  but  this  is  only  a  process  of  subduing 
the  patient.  A  sick  person  does  not  possess  too  much 
blood,  nor  too  much  vital  power.  Sickness  does  not 
add  to  his  capital  stock  of  vitality ;  nor  does  a  preter¬ 
natural  supply  of  vital  energy  ever  occasion  disease, 
for  it  never  exists.  The  difficulty,  in  all  cases  of  in¬ 
flammation,  and  in  all  cases  of  disease,  is  in  unbalanced 
determination  of  vital  action,  and  in  irregular  dis¬ 
tribution  of  the  blood,  as  I  have  heretofore  explained. 

This  subject  has,  perhaps,  some  special  importance 
at  this  time,  because  the  old  and  oft-exploded  doctrines 
of  a  by-gone  age — that  bleeding  and  other  reducing 


Stimulation  vs.  Antiphlogistication.  267 

measures  should  be  resorted  to  in  treating  diptheria, 
because  it  is  an  inflammatory  affection — and  that 
typhus  fever  is  a  result  and  not  an  attendant  of  inflam¬ 
mation,  are  being  revived  by  modern  physicians. 

As  an  illustration  of  the  propriety  of  these  remarks, 
and  as  a  basis  of  some  further  criticisms  on  the  sub¬ 
ject,  the  following  article,  which  I  find  in  one  of 
the  New  York  newspapers,  of  large  circulation,  is 
subjoined: 

“AN  INTERESTING  MEDICAL  PAPER. 

“SOEE  TIIEOAT,  EEMITTENT  AND  TYPHUS  FEVEES. 

“  These  diseases  are  to  a  considerable  extent  prevail¬ 
ing,  and  with  some  fatality.  Any  remarks  about  the 
treatment  which  tends  to  cure  them  will  be  of  service 
to  the  people. 

“  Some  time  ago,  a  lecture  was  delivered  at  the  Med¬ 
ical  College  in  Twentieth  Street,  by  Dr.  Sherrill,  on  the 
epidemic  sore-throat  distemper.  It  was  published  in 
the  Christian  Messenger.  In  the  remarks  made,  it  was 
assumed  and  shown  that  the  throat  disease  was  purely 
of  an  inflammatory  nature ;  that  the  symptoms  of 
typhus,  gangrene,  or  what  is  called  diptheria,  are  effects 
of  inflammation,  and  very  likely  may  be  avoided  by 
active  and  suitable  means  early  used  to  check  such  an 
inflammation.  To  effect  this,  all  irritating  stimulants 
and  alcoholic  mixtures  are  not  advisable  and  are  in¬ 
jurious.  A  great  many  facts  and  authorities  are  in¬ 
troduced  to  sustain  this  theory  ;  it  is  stated  that  by 
the  mode  of  treatment  detailed  in  this  essay,  more  than 
two  hundred  cases,  in  various  states  and  stages,  have 
been  treated,  and  that  with  two  exceptions  all  re¬ 
covered. 

“In  illustration  of  this  subject,  it  is  stated  that  a 
typhous  or  gangrenous  condition  has  been  represented 


268 


Diptheria. 


to  have  taken  place  in  the  throat  disease,  for  which 
opium,  stimulants,  and  alcoholic  articles  have  been  rec¬ 
ommended  and  given.  It  appears  that  a  state  of 
typhus  is  preceded  by  fever  of  an  inflammatory  na¬ 
ture,  as  it  is  in  this  case,  and  also  in  remittent  fever 
which  precedes  a  typhoid  state  when  it  takes  place, 
aud  that  in  the  first  stage  it  is  of  an  inflammatory  or 
congestive  type.  This  is  a  very  interesting  position  to 
take,  and  if  it  is  correct,  may  or  ought  to  have  an 
important  influence  on  the  treatment.  It  may  be  a 
means  of  inducing  prescribers  to  avoid  the  free  use  of 
stimulants  and  alcohol,  which  are  frequently  used. 
There  are  many  authorities  named  in  favor  of  these 
statements.  The  address  will  further  explain  on  this 
subject  by  an  extract: 

“  ‘  It  is  doubtful  whether  in  this  climate  any  febrile 
disease,  in  its  incipient  stage,  is  of  a  typhous  condition, 
so  as  to  be  benefited  early  by  stimulant  or  alcoholic 
articles.  The  state  of  typhus  which  takes  place  accord¬ 
ing  to  the  writer’s  observations  has  been  the  sequence 
of  an  inflammatory  or  congestive  state  of  the  body 
not  arrested  in  the  early  stage.’ 

“  Typhus  was  considered  to  be  preceded  by,  and  be 
the  result  of,  an  inflammation  of  some  of  the  inner  or¬ 
gans,  by  Clutterbuck,  Armstrong,  Broussais,  Bush, 
Donaldson  and  Maygell,  and  that  at  first  the  treatment 
should  be  to  relieve  and  cure  such  a  condition  of  the 
body.  Bemittent  fevers,  which  prevail  in  summer  and 
autumn,  in  the  first  stage  are  of  an  inflammatory  or 
congestive  state,  and  a  depleting  and  refrigerant 
course  of  treatment  is  always  the  most  successful. 
This  will  be  a  means  of  checking  the  progress  of  the 
case  and  preventing  a  state  of  typhus  from  taking  place, 
and  the  case  may  be  cured  in  much  less  time  than  those 


Stimulation  ys.  Antipiilogistication.  269 

cases  are  generally  cured.  A  great  many  years  of  ob¬ 
servation  and  practice  in  treating  and  curing  many 
hundreds  of  such  cases  justifies  these  statements. 

“  The  following  sketches  are  taken  from  a  collection 
of  essays  on  epidemic  diseases  collected  by  Dr.  H. 
Sherrill: 

u  In  1825  the  remittent  and  typhus  fever  prevailed 
in  many  places  along  the  Hudson  Diver,  in  an  epi¬ 
demic  form,  and  more  than  commonly  severe.  Some 
sketches  of  a  history  of  it  was  read  at  the  annual  meet¬ 
ing  of  the  Duchess  County  Society  that  fall.  An  ab¬ 
stract  from  it  is  here  made  :  ‘  Generally  the  cases  ex¬ 
hibited  inflammatory  action,  but  in  many  instances 
there  was  a  small  flaccid  pulse,  like  that  which  often 
took  place  in  the  epidemic  of  1812.  There  was  dull  or 
intense  headache — dull  appearance  of  the  eyes — a  lurid 
face— a  tired  aching  of  the  limbs — the  tongue  was  con¬ 
tracted,  pointed,  and  very  red,  in  some  cases  there  was 
great  prostration  and  congestion ;  when  the  disease 
was  not  checked  early,  a  state  of  typhus  set  in,  and  this 
might  be  tedious,  obstinate,  or  fatal.’ 

“  The  most  suitable  treatment  was,  in  the  early  stage, 
to  use  active  means  to  remove  congestion  and  an  in¬ 
flammatory  state  ;  for  this  purpose  free  blood-letting 
was  the  most  useful  remedy ;  all  the  after-symptoms 
were  shaped  or  controlled  by  the  use  or  omission  of 
this  remedy.  In  those  cases  where  there  was  great  de¬ 
pression  or  congestion,  and  the  pulse  was  small  and 
flaccid,  as  it  generally  is  in  such  a  state  of  disease,  the 
portion  of  blood  taken  at  first  was  small,  and  the  oper¬ 
ation  repeated,  as  was  practiced  in  the  epidemic  of  1812 
and  in  that  of  1193,  as  recommended  and  used  by  Dr. 
Kush  ;  in  such  a  condition,  the  pulse  always  on  bleed¬ 
ing  rises  and  is  more  full  and  firm  *  the  blood  was  very 


270 


Dipthekia. 


black ;  the  medicine  used  was  of  a  refrigerating,  su¬ 
dorific  nature.  There  were  as  many  as  twenty -five 
cases  treated  in  this  way  (which  was  large  for  a  sparse- 
settled  country  district) ;  the  fever  run  out,  and  a  crisis 
formed  the  ninth  day  ;  there  were  no  stimulants  given 
till  after  the  crisis,  and  very  little  then  ;  nourishment 
was  mostly  relied  upon  to  restore  the  strength.  Many 
of  the  cases  assumed  a  typhous  state,  but  it  was  soon 
controlled  ;  there  was  not  one  case  fatal. 

“  In  many  instances,  and  in  most  places,  from  inform¬ 
ation  received  and  reports  made,  attempts  were  made 
to  cure  this  disease  by  alexipliarmic  remedies,  such  as 
mercury,  opium,  sudorific  cordial,  and  alcoholic  mix¬ 
tures,  and  those  were  freely  used  ;  in  this  way  a  long, 
tedious  illness  ensued  ;  the  case  run  on  three,  four,  five, 
or  six  weeks ;  the  patient  got  a  black  tongue  and  teeth, 
stupor,  delirium,  nervous  irritation,  and  a  train  of 
those  symptoms  called  typhous  ;  frequently  the  case 
terminated  in  death. 

“  It  is  a  fair  inference  to  make,  that  under  similar 
treatment  corresponding  results  would  occur  at  this 
time. 

“  Cases  similar  to  those  detailed,  it  appears,  at  this 
time  may  be  cured  or  prove  tedious  and  fatal  accord¬ 
ing  to  the  mode  of  treatment,  as  the  following  may 
show : 

“  ‘R.  I.,  Dec.  20,  1861. 

“  £  Took  a  cold,  which  increased  so  that  on  the  28th 
he  took  to  bed  with  fever,  pain  in  the  head,  nausea, 
soreness  and  aching  of  the  limbs,  rather  prostrated  press¬ 
ure  of  the  chest.  Jan.  2, 1862  :  When  I  first  saw  him 
he  was  inclined  to  stupor — tongue  contracted  and  red 
— bowels  costive  ;  he  appeared  to  have  foaming  com 


Stimulation  ys.  Antiphlog-istication.  27  i 

gestion  of  the  brain  or  lung — pulse  compressible,  a 
beginning  of  the  state  called  typhoid. 

“  c  From  the  arm  sixteen  ounces  of  blcod  were  taken  ; 
it  was  black,  and  deprived  of  a  required  quantity  of 
vital  air  ;  it  soon  was  as  firm  as  liver  ;  means  were  used 
to  open  the  bowrnls  ;  he  wras  put  upon  the  use  of  homeo¬ 
pathic  medicine  ;  these  were  varied  from  time  to  time 
to  operate  on  the  symptoms  presented.  After  the  use 
of  the  first  remedies,  the  pulse  became  more  full  and 
firm.  This  was  the  case,  by  such  means,  in  the  epi¬ 
demic  of  1812,  and  in  the  epidemic  cholera.  He  was 
given  as  much  cold  water  as  he  would  lake  ;  he  took 
no  nourishment,  except  gruel  or  the  like  ;  all  stimu¬ 
lant  and  alcoholic  articles  were  excluded  ;  the  fever 
and  disease  gradually  abated.  On  the  10th  the  fever 
subsided  and  a  crisis  formed,  so  that  on  the  12th  he 
set  up,  and  for  a  short  time  read  the  news  ;  the  tongue 
retained  a  redness,  attended  with  flushes  of  fever,  so 
that  remedies  were  still  given  to  remove  those  symp¬ 
toms  of  a  trail  of  inflammatory  action  ;  even  nourish¬ 
ment  was  sparingly  given,  and  no  alcoholic  mixtures 
wmre  allowed.  He  regularly  improved,  daily  walked 
the  room,  and  by  the  20th  went  down  stairs,  fully 
cured.  Medicus.’ 

“  The  following  case  took  place  about  the  same  time 
as  the  preceding  one.  It  was  communicated  by  the 
nursery  attendants  : 

“  A.  B.  was  attacked  precisely  like  the  other.  After 
about  ten  days’  lingering  was  taken  to  bed  with  symp¬ 
toms  similar  to  the  preceding  case.  In  four  days  he 
was  greatly  prostrated  and  distressed  ;  the  tongue  was 
very  red  and  pointed ;  it  was  now  around  that  he  had 
typhoid  fever;  before  the  fever  ended  or  a  crisis  formed 
he  was  given  beef-tea,  and  was  soon  put  upon  the  use 


272 


Diptheria. 


of  port  wine  ;  he  soon  inclined  to  stupor  and  indiffer¬ 
ence  ;  by  the  advice  of  several  doctors,  called  respect¬ 
able  prescribes,  the  stimulants  were  increased  ;  a  black 
scurf  formed  on  the  tongue  and  teeth,  the  edges  of  the 
tongue  retaining  a  lively  redness.  To  keep  him  from 
running  down  and  sinking,  brandy  was  added  to  the 
other  means ;  he  was  very  uneasy,  attended  with  ner¬ 
vous  irritation  and  an  impaired  mind.  In  this  way  he 
struggled  along  for  five  weeks,  and  then  died. 

“  In  a  history  of  the  epidemic  of  1812,  as  it  appeared 
in  Duchess  County,  which  was  described  as  a  remit¬ 
ting  bilious  fever,  in  many  cases  it  was  attended  with 
inflammation  and  congestion  of  some  of  the  internal 
organs.  "When  not  early  checked  or  relieved,  it  was 
strongly  inclined  to  pass  into  a  state  of  typhus  or  gan¬ 
grene.  In  a  township  containing  2,400  inhabitants, 
there  were  about  130  cases.  It  was  generally  looked 
upon  by  the  people  and  the  medical  men  as  a  state 
of  direst  weakness  and  of  a  typhoid  tendency,  and  re¬ 
course  was  had  to  a  free  use  of  a  great  variety  of 
stimulants  and  alcoholic  mixtures  to  keep  off  typhus, 
‘  to  keep  the  patient  from  running  down  into  typhus 
and  gangrene.’  A  clergyman  of  the  place  set  down 
the  names  of  those  who  died.  It  footed  63 — one 
half ! 

“  In  another  district,  of  about  the  same  population, 
there  were  about  150  cases  of  the  same  epidemic. 
They  were  treated  by  free  blood-letting  and  refrigerant 
remedies.  No  alcohol  was  used  until  the  congestion 
and  fever  were  removed  and  a  crisis  formed.  Of 
these  it  is  stated  that  ninety-four  per  cent,  were  cured. 

“  Several  years  afterward  the  work  of  Surgeon-Gen¬ 
eral  Mann  and  Prof.  Gallup  appeared,  which  treated 
on  this  epidemic  of  1812.  They  advocated  and  recoin- 


Stimulation  vs.  Antiphlogistication.  273 

mended  tlie  same  doctrine  and  practice  which  has  just 
been  mentioned,  by  which  it  appeared  that  in  the  army 
the  proportion  cured  was  over  ninety  per  cent. 

“  In  those  essays  of  Messrs.  Mann  and  Gallup  it  is 
stated  that  in  the  vicinity  of  the  army,  among  the 
people,  a  stimulant  treatment  for  the  epidemic  fre¬ 
quently  was  used,  and  that  one  fourth  to  one  half  the 
cases  were  fatal. 

“  In  a  report  from  Dr.  Lovell,  it  is  stated  that  in  one 
village  and  vicinity  where  the  stimulant  practice  was 
freely  used,  in  the  month  of  January,  1812,  there  were 
seventy-three  deaths.  During  this  time  there  were 
one  hundred  cases  in  the  army,  which  were  treated  by 
blood-letting,  etc.,  of  which  only  three  proved  fatal. 

“  With  such  glaring  statements  before  us,  is  it  not 
surprising  that  a  great  and  obstinate  prejudice  against 
bleeding  exists  in  the  community  ?  By  it,  no  doubt, 
many  a  one  has  lost  his  life.  If  the  Sanitary  Board 
of  the  army  could  be  induced  to  review  the  facts,  and 
they  could  be  made  to  produce  a  fair  influence  on  the 
general  mind,  many  of  the  soldiers  might  have  their 
lives  preserved,  who  now  fall  victims  to  typhus,  qui¬ 
nine,  and  alcohol,  and  the  government  might  save  the 
immense  sums  which  these  popular  drugs  cost.” 

It  would  be  difficult  to  compress  a  greater  number 
of  pathological  errors  and  therapeutic  mistakes  into  so 
small  a  compass.  Scientifically,  it  is  a  mere  “  budget 
of  blunders.”  But  as  it  represents  the  theory  and 
practice  of  about  an  equal  moiety  of  the  medical  pro¬ 
fession  of  the  whole  civilized  world,  it  is  entitled  to 
candid  consideration  and  respectful  refutation. 

Dr.  Sherrill  assumes  that  typhus  is  an  effect  of  in¬ 
flammation,  and  that  by  promptly  reducing  the  inflam¬ 
mation,  that  is,  by  employing  bleeding  and  antiphlo- 

12* 


274 


Diptheeia. 


gistic  drugs  in  tlie  early  stage,  the  consequential 
“  typhous  condition”  may  be  averted. 

Nothing  can  be  further  from  the  truth,  and  no  doc¬ 
trine  could  be  more  mischievous  in  practice.  It  has 
already  slain  its  millions.  Typhus  or  typhoid  fever, 
or  a  “  typhous  condition,”  means  nothing  more  nor  less 
than  a  continued  fever,  with  or  without  the  concurrence 
of  an  acute  local  inflammation,  in  which  the  remedial 
effort  is  not  chiefly  and  persistently  determined  to  the 
whole  surface  of  the  body.  If  the  determination  of 
remedial  effort — the  u  fever,”  or  “  reaction”  of  medical 
authors — is  decidedly  and  permanently  directed  to  the 
whole  surface,  the  fever  is  properly  called  entonic  or 
sthenic ;  otherwise  it  is  asthenic,  atonic,  or  typhous. 
In  all  forms  of  remittent  fever,  diptheria,  malignant 
scarlet  fever,  putrid  or  epidemic  sore  throat,  the 
diathesis,  both  of  the  local  and  the  constitutional  dis¬ 
ease — the  inflammation  and  the  fever — is  invariably 
atonic  in  all  stages.  The  disease  commences  with  the 
“  typhous  condition,”  progresses  with  the  “  typhous  con¬ 
dition,”  and  ends  with  the  “  typhous  condition.”  And 
the  effect  of  bleeding  and  other  reducing  processes  and 
agents  is  always  to  aggravate  the  “  typhous  condition,” 
and,  when  the  patient  is  so  lucky  as  to  survive  the 
disease  and  medication,  to  prolong  the  convalescence, 
and  render  recovery  imperfect. 

Dr.  Sherrill  does  well  in  objecting  to  alcoholic  and 
other  stimulants,  notwithstanding  we  have  a  formi¬ 
dable  array  of  authorities  in  their  favor ;  but  he  resorts 
to  antiplilogistics  because  stimulants  are  injurious,  he 
commits  an  error  quite  equal,  and  even  more  disastrous 
in  results,  to  the  mistake  of  those  who  recommend 
alcoholic  stimulants  because  antiphlogistics  are  in- 
j  urious. 


Stimulation  vs.  Antiphlogistication.  275 

Is  there  not  something  marvelously  strange  in  this 
controversy?  Was  the  like  of  it  ever  heard  of  or 
thought  of  on  the  face  of  the  earth?  Were  scientific 
men  ever  in  a  similar  muddle  on  any  other  subject  ? 

Here  is  a  learned  body  of  men — 40,000  strong  in 
the  United  States — divided  into  two  classes  nearly 
equal  in  number,  character,  and  experience — one  class 
condemning  stimulants  and  approving  antiphlogistics, 
and  the  other  class  condemning  antiphlogistics  and 
approving  stimulants.  And  each  party  refers  to  its 
own  observations  and  experience  to  prove  that  its  own 
practice  is  all  right,  and  that  the  opposite  treatment  is 
all  wrong.  What  can  such  experience  be  worth  ? 

And  so  the  profession  might  go  on  another  three 
thousand  years,  ravaging  the  human  constitution  with 
poisonous  drugs,  and  sending  the  human  race  in  con¬ 
stant  droves  to  premature  graves,  and  justify  their 
doings  by  “  observation  and  experience.”  Never, 
never  will  their  destroying  hand  be  stayed  until  a 
true  theory  is  understood,  by  which  the  facts  of  observ¬ 
ation  and  experience  may  be  judged  and  applied. 

Whether  a  stimulant  or  an  antiphlogistic  plan  of 
treatment  is  most  successful,  or  rather,  whether  one 
or  the  other  is  less  injurious,  depends  entirely  on  the 
degree  of  atony  or  debility — -on  the  greater  or  less 
degree  of  the  asthenic  or  typhoid  condition  of  the 
system.  In  ordinary  cases  there  would  be  little  to 
choose.  In  these  cases  the  patient  will  recover  in 
spite  of  a  great  amount  of  injurious  medication, 
whether  of  the  stimulant  or  the  antiphlogistic  kind  ; 
and  as  the  great  majority  of  cases  are  of  this  charac¬ 
ter,  the  “  success”  of  either  plan,  according  to  the 
ordinary  operations  of  the  law  of  chance,  would  be 
nearly  equal.  And  this  fact  alone  solves  the  problem 


276 


Dipthebia. 


wdiy  it  is  that  the  advocates  of  the  opposite  plans  of 
treatment  can  never  agree.  But  in  the  mildest  cases 
the  stimulant  plan  would  be  worse  than  the  antiphlo¬ 
gistic  ;  while  in  the  severest  cases  the  antiphlogistic 
treatment  would  be  more  fatal  than  the  stimulant. 

The  subject  is,  however,  still  further  complicated 
by  the  different  degrees  or  potencies  of  stimulation  or 
antiphlogistication  to  which  different  physicians  resort. 
Some  of  the  stimulating  doctors  use  mild  stimulants 
in  moderate  doses,  while  others  employ  strong  stim¬ 
ulants  in  large  doses.  And  so  with  the  antiphlogis- 
ticating  practitioners.  Some  employ  the  most  deadly 
reducing  agents  of  the  materia  medica,  wdiile  others 
prescribe  only  the  milder  poisons  of  the  same  class. 
All  of  these  circumstances  must  be  taken  into  the 
account  in  estimating  the  effects  of  either  plan  of  treat¬ 
ment.  And,  I  apprehend,  the  perfect  understanding 
of  the  whole  subject  will  bring  the  reader  to  the  con¬ 
clusion  that  all  physicians  have  come  to,  who  have 
fully  investigated  the  subject,  viz. :  the  less  drug-med¬ 
ication  of  any  kind,  the  better  for  the  patient. 


